Relief of the pain of neuromas-in-continuity and scarred median and ulnar nerves in the distal forearm and wrist by neurolysis, wrapping in vascularized forearm fascial flaps and adjunctive procedures.
This prospective study reports treatment by neurolysis then wrapping the nerves in vascularized forearm fascia and, when necessary, adjunctive procedures of twelve median and two ulnar nerves in continuity in the distal forearm with neurogenic pain. Preoperatively, all 14 patients had severe pain in at least one of the five modalities of pain analysed. There was complete resolution of all modalities of pain in eight of 14 patients following neurolysis and fascial nerve wrap surgery and two more patients had only mild pain in one or two modalities. After the addition of wrist pinning or arthrodesis alone or in conjunction with selective division of flexor tendons in four patients, there was complete resolution of all modalities of pain in nine of 14 patients. A further three patients had mild pain in three or less modalities and only one patient continued to have severe pain in one modality.
Elliot
D
D
Department of Plastic Surgery, St Andrew's Centre, Broomfield Hospital, Chelmsford, UK. info@david-elliot.co.uk
Lloyd
M
M
Hazari
A
A
Sauerland
S
S
Anand
P
P
D000293:Adolescent; D000328:Adult; D001134:Arm Injuries / Q000150:complications; D002921:Cicatrix / Q000150:complications*; D015331:Cohort Studies; D003714:Denervation; D005205:Fascia; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D009463:Neuroma / Q000150:complications*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply; D016896:Treatment Outcome; D014459:Ulnar Nerve; D055815:Young Adult