title: The novel treatment of SVF-enriched fat grafting for painful end-neuromas of superficial radial nerve.
abstract: BACKGROUND
  None of the existing treatments in the management of painful end-neuromas of the superficial branch of the radial nerve (SBRN) has been proven superior due to high levels of pain relapse. Fat grafts enriched with the stromal vascular fraction (SVF) could act as a mechanic barrier with biological effects decreasing the resorption rate and boosting the graft's regenerative potential. This study describes the novel surgical treatment technique of SVF-enriched fat grafting.
  
  
  METHODS
  In this clinical study, five consecutive patients treated for painful end-neuromas of the SBRN between 2012 and 2013 were analyzed retrospectively. Microsurgical resection of end-neuromas followed by SVF-enriched fat grafting around the nerve stump was performed in all patients. Five different pain modalities and various predictors were compared pre- and up to 36 months postoperatively.
  
  
  RESULTS
  Pain reduction observed at 2 months after surgery was constant over time, though not statistically significant compared to preoperative levels. Spontaneous pain could be reduced from 1.6 ± 0.55 to 1.2 ± 1.1 (p = 0.414), spikes from 2.2 ± 1.3 to 1.4 ± 1.34 (p = 0.180), hyperaesthesia from 1.6 ± 1.14 to 1.2 ± 1.64 (p = 0.713), tap pain from 2.8 ± 0.45 to 1.8 ± 1.3 (p = 0.197) and motion pain from 2.8 ± 0.45 to 1.4 ± 1.34 (p = 0.066). An improvement in overall pain reduction could be observed from 2.2 ± 0.97 to 1.4 ± 1.26 3 years after the surgery (p = 0.104).
  
  
  CONCLUSIONS
  SVF-enriched fat grafting represents another alternative to numerous available treatments of painful end-neuromas of the SBRN. Our preliminary results could not show any significant difference in pain reduction following SVF-enriched fat grafting. Further larger trials are required in order to evaluate the therapeutic potential of SVF-enriched fat grafting.
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Maurizio
authors.identifier: http://orcid.org/0000-0003-4372-0561
authors.initials: M
authors.lastname: Calcagni
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Zimmermann
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Scaglioni
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Giesen
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
authors.affiliation: Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Fakin
mesh_terms: D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D009463:Neuroma / Q000150:complications / Q000601:surgery*; D010147:Pain Measurement; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000601:surgery*; D011826:Radial Nerve / Q000601:surgery*; D012189:Retrospective Studies; D050151:Subcutaneous Fat / Q000166:cytology / Q000637:transplantation*; D016896:Treatment Outcome