title: Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps.
abstract: OBJECTIVE
  To review the outcomes of 8 patients with painful median nerve neuromas at the wrist treated with external neurolysis and covered with pedicled perforator adipofascial flaps.
  
  
  METHODS
  Between 2004 and 2010, we treated 8 patients, who had a mean age of 37 years, and who had posttraumatic painful median nerve neuromas at the level of the wrist but with retained median nerve function . All of them reported neuropathic pain and had a positive Tinel's sign over the site of the presumed neuroma. The surgical procedure included external neurolysis and coverage with an ulnar artery perforator adipofascial flap (4 patients) or with a radial artery perforator adipofascial flap (4 patients). Patients were reviewed after a mean follow-up of 41 months (range, 18-84 mo). Preoperative and postoperative pain was measured with a visual analog scale.
  
  
  RESULTS
  Pain improved from a preoperative mean value of 7.8 to a postoperative mean value of 3.6. There was complete resolution of pain in 5 patients, mild pain persisted in 2 patients, and 1 patient reported no improvement. No complications occurred at the donor site.
  
  
  CONCLUSIONS
  Vascularized soft tissue coverage of painful median nerve neuromas is an effective treatment. We do not believe that a free flap is of any particular advantage over a local pedicle flap which we suggest using to protect the median nerve.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Hand Surgery and Microsurgery, University Hospital of Verona, Verona, Italy; Department of Microsurgery, CTO Torino, Torino, Italy; Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: roberto.adani@ospedaleuniverona.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Adani
authors.affiliation: Department of Hand Surgery and Microsurgery, University Hospital of Verona, Verona, Italy; Department of Microsurgery, CTO Torino, Torino, Italy; Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tos
authors.affiliation: Department of Hand Surgery and Microsurgery, University Hospital of Verona, Verona, Italy; Department of Microsurgery, CTO Torino, Torino, Italy; Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarallo
authors.affiliation: Department of Hand Surgery and Microsurgery, University Hospital of Verona, Verona, Italy; Department of Microsurgery, CTO Torino, Torino, Italy; Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Corain
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve; D009463:Neuroma / Q000601:surgery*; D010147:Pain Measurement; D061525:Perforator Flap; D016896:Treatment Outcome
keywords: Median nerve; fascial flaps; neuroma; pain; perforator flaps