Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas.

Nine patients divided into two groups were treated for pedunculated supernumerary digits or their sequelae. The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. Adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy.

Effect of a modified Nd:YAG laser technique on neuroma formation: An experimental study in rat sciatic nerve.

BACKGROUND AND OBJECTIVES: Traumatic transection of a peripheral nerve is inherently associated with the development of neuroma at the end of the proximal stump, often leading to therapy-resistant pain. This study was designed to evaluate whether the neodymium:yttrium aluminum garnet (Nd:YAG) laser could prevent neuroma formation after neurectomy. STUDY DESIGN/MATERIALS AND METHODS: The sciatic nerves of 14 rats were diffuse coagulated by defocused Nd:YAG laser (12 W power), and subsequently transected with additional focused laser energy. The control group consisted of contralateral nerves transected by microscissors. The nerves were reexposed at different time intervals up to 9 weeks after surgery, and evaluation consisted of macroscopy, and light and transmission electron microscopy. RESULTS: True neuroma formation could not be observed after laser transection, and only five nerves formed a neuromatous bulb, with minimal adhesions to surrounding tissue. Microscissor transection resulted in widespread amputation neuromas, consisting of regenerating axons and connective tissue, and nervous tissue regenerating into surrounding tissue. Laser-transected nerves showed degenerative changes of the axons and myelin, while proliferation of Schwann cells could not be observed. No outgrowth of axons could be observed outside the coagulated proximal stump. An epi/perineurial layer was present, covering the nerve stumps. Microscissor-transected nerves showed proliferation of fibroblasts and Schwann cells, forming minifascicles, and vigorous outgrowth of axons into the tissue and even into the distal nerve stump. CONCLUSIONS: Within the limitations of this study it is concluded that the formation of amputation neuromas is suppressed by Nd:YAG laser application by thermal coagulation of the nerve and suppression of Schwann-cell proliferation.