title: Treatment of posttraumatic painful neuromas at the digit tip using neurovascular island flaps.
abstract: OBJECTIVE
  We report the treatment of 9 patients with 9 painful neuromas at the tips of the digits using reverse pedicled island flaps containing subcutaneous nerves that were connected to the digital nerve stumps after removal of the neuromas.
  
  
  METHODS
  There were 9 patients (7 men and 2 women) with painful cutaneous neuromas at the tips of the digits. The ages of the patients at time of surgery were 21 to 66 years (mean, 46 y). All neuromas were formed in the palmar digital nerves in the hand. Preoperative and postoperative status of the patients with neuromas were assessed and graded using a system modified from previously described grading systems for patients with neuromas. Recovery of sensation in the transplanted skin islands was assessed using the Semmes-Weinstein monofilament test.
  
  
  RESULTS
  In the preoperative assessment of patients using the grading system for neuromas, 3 patients were assessed as grade 4 (severe), 5 patients as grade 3 (moderate), and the remaining patient as grade 2 (mild). After surgery, Tinel sign disappeared completely in 6 of 9 patients. According to the grading system for neuromas, 6 patients were assessed as grade 1 (normal), and the other 3 patients were assessed as grade 2 (mild) postoperatively. Using the Semmes-Weinstein monofilament test for assessing recovery of sensation of the skin islands, 3 patients recognized the 2.83 monofilament (normal), 2 patients recognized the 3.22 monofilament (loss of tactile sense), and the remaining 4 patients recognized the 3.66 monofilament applied (loss of tactile sense).
  
  
  CONCLUSIONS
  This skin island approach provided us with good pain control and recovery of hand function after painful neuromas.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopedic Surgery & Rehabilitation Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. kakinoki@kuhp.kyoto-u.ac.jp
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kakinoki
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Ikeguchi
authors.forename: Ahamed N
authors.initials: AN
authors.lastname: Atiyya
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005383:Finger Injuries / Q000150:complications; D005385:Fingers / Q000294:innervation / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000145:classification / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017169:Neoplasms, Post-Traumatic / Q000601:surgery*; D009437:Neuralgia / Q000145:classification / Q000209:etiology / Q000601:surgery; D009463:Neuroma / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013524:Surgical Flaps