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Case Reports
. 2018 Oct 26:19:1-5.
doi: 10.1016/j.jpra.2018.10.001. eCollection 2019 Mar.

Treatment of a patient suffering from posttraumatic painful neuromas formed at the bilateral digital nerves of the left middle finger using two neurovascular island flaps

Shunki Iemura  1 , Ryosuke Kakinoki  1 , Kazuhiro Ohtani  1 , Kazuhiko Hashimoto  1 , Fumihisa Nakamura  1 , Hiroki Tanaka  1 , Masao Akagi  1
Affiliations
Case Reports

Treatment of a patient suffering from posttraumatic painful neuromas formed at the bilateral digital nerves of the left middle finger using two neurovascular island flaps

Shunki Iemura et al. JPRAS Open. .

Erratum in

Abstract

Hand surgeons often encounter painful posttraumatic neuromas in daily practice and the treatment of these neuromas is still challenging for them, because of the tendency of recurrence.1,2 The patient injured his left middle finger and was treated by amputation in a previous hospital. After this operation, the patient started to feel pain at the fingertip and complained of severe electric radiating pain when the radial and ulnar ends of the finger were touched. We treated painful neuromas formed on both palmar digital nerve stumps using a reverse pedicle island flap containing subcutaneous nerves, which were connected to the nerve stumps after removal of the neuromas of the finger. This maneuver relieved the finger pain completely. Removal of finger digital nerve neuromas, connecting the nerve stumps to the subcutaneous nerves included in a skin island flap and, covering the neurorrhaphy sites with the flap may have reduced the chance of the recurrence of neuromas and resulted in restoration of considerable function of the hand.

Keywords: Digit tip amputation; Neurovascular island flap; Painful neuromas; Scar tissue.

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Figures

Figure 1.
Figure 1
Schematic diagram of the operation. A: donor site of the flap. B: neurovascular island flap, C: radial palmar digital artery, D: radial palmar digital nerve, E: dorsal branch of the radial palmar digital nerve, F: radial dorsal digital nerve, G: a stump of the ulnar palmar digital nerve, H: a stump of the radial palmar digital nerve, I: distal stump of the dorsal branch of the radial palmar digital nerve (coagulated). J: proximal stump of the dorsal branch of the radial palmar digital nerve, K: proximal stump of the dorsal digital nerve (coagulated), L: proximal stump of the radial palmar digital artery (ligated).
Figure 2.
Figure 2
Left: Exploration of the amputated finger tip. The amputated stumps of the bilateral palmar digital nerves were identified. a: stump of the ulnar palmar digital nerve, b: stump of the radial palmar digital nerve. Middle: the radial palmar digital artery and the surrounding fat tissue were separated from the radial palmar digital artery. c: the radial palmar digital artery. Right: Skin defects at the flap donor site and over the vascular pedicle of the flap were covered by an artificial dermis (d). e: the neurovascular flap was drastically reduced.
Figure 3.
Figure 3
The left middle finger tip one year after surgery. The flap survived, and pain was represent.
See this image and copyright information in PMC

References

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    1. Mackinnon SE, Dellon AL, Hudson AR. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg. 1985;76:345–353. - PubMed
    1. Domeshek LF, Krauss EM, Snyder-Warwick AK. Surgical treatment of neuromas improves patient-reported pain, depression, and quality of life. Plast Reconstr Surg. 2017;139(2):407–418. - PubMed
    1. Kakinoki R, Ikeguchi R, Atiyya AN. Treatment of posttraumatic painful neuromas at the digit tip using neurovascular island flap. J Hand Surg. 2008;l33A:348–352. - PubMed

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