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Surgical Treatment of Symptomatic End-Neuroma With a New Bioresorbable Copolyester Nerve Capping Device A Multicenter Prospective Cohort Study
Univ Hosp Birmingham NHS Fdn Trust, England.
Stanford Univ, CA USA.
Inst Main Nantes Atlantique, France.
Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.ORCID iD: 0000-0003-2792-9525
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2023 (English)In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 91, no 1, p. 109-116Article in journal (Refereed) Published
Abstract [en]

BackgroundNeuroma-induced neuropathic pain is associated with loss of function and reduced quality of life. No consistently effective standard-of-care treatment has been defined. Neurocap, a bioresorbable nerve capping device, has been designed to isolate the nerve stump from surrounding tissues to reduce development of symptomatic end-neuromas.MethodsPatients with peripheral symptomatic end-neuromas were included in a prospective, multicenter, single-arm design. Data were collected presurgery up till 24 months postsurgery. Eligible patients with neuromas were identified based on blocks using anesthetic. Intervention included surgical excision and capping of the transected proximal nerve end with the Neurocap. Main outcome measures were pain, function, recurrence of symptomatic neuroma, use of analgesics, and adverse events.ResultsIn total, 73 patients with 50 upper-extremity and 23 lower-extremity end-neuromas were enrolled. End-neuromas were predominately located in the digits and lower leg. Statistical power of the study outcomes was preserved by 46 of 73 patients completing 24-month follow-up. The mean VAS-Pain score at baseline was 70.2 & PLUSMN; 17.8 (scale 0-100) and decreased significantly to 31 & PLUSMN; 32.5 (P < 0.001). Function significantly improved over time. The recurrence rate of confirmed symptomatic neuroma was low (2 of 98 capped nerves). Adverse event rate was low and included pain and infection; there were no unexpected device-related adverse events. Most patients reported lower use of nonsteroidal anti-inflammatory drugs, opioids, and antineuropathic medications at last follow-up compared with baseline.ConclusionsEnd-neuroma treatment with excision and capping resulted in long-term significant reduction in reported pain, disability, and analgesic medication use. Adverse event rate was low.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS , 2023. Vol. 91, no 1, p. 109-116
Keywords [en]
nerve capping; Neurocap; symptomatic neuroma
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-196730DOI: 10.1097/SAP.0000000000003596ISI: 001030405200020PubMedID: 37450869OAI: oai:DiVA.org:liu-196730DiVA, id: diva2:1790059
Available from: 2023-08-22 Created: 2023-08-22 Last updated: 2023-08-22

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Nyman, Erika
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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Hand and Plastic Surgery
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