Surgical Outcomes of Spiral Vein Wrapping Flaps for Painful Neuromas: A Case Series Analysis.

Abstract

BACKGROUND Neuropathic pain symptoms caused by neuromas impose physical burdens and affect patients mentally and socioeconomically. Surgical intervention offers more promising outcomes than do conservative approaches. An accessible and cost-effective surgical treatments is neuroma excision, coupled with nerve wrapping flaps. However, few reports have detailed the outcomes of this approach. In this study, we report 4 patients who underwent neuroma excision and nerve wrapping with vein autographs. CASE REPORT We present 4 patients who experienced persistent neuropathic pain and did not respond to conservative treatment for more than 6 months. Three patients had upper limb neuromas in continuity and 1 patient had a stump femoral neuroma. Surgical intervention involved neuroma excision, nerve grafting, and the application of nerve wrapping flaps at the site of anastomosis. Evaluation of our patients included neuroma pain scores and the Weber 2-point discrimination test. Follow-up assessments demonstrated significant clinical improvement, with all patients showing up to 60% reduction in pain and an average improvement of 5 mm in 2-point discrimination. No recurrence or need for further surgery was observed. CONCLUSIONS Surgical intervention was superior to conservative treatment in patients with painful neuromas. Nerve wrapping flaps, one of the surgical procedures for neuroma management, represents an effective surgical option for neuromas in continuity and stump neuromas. This is related to the more physiological nerve regeneration process when nerve ends are closed. The use of autograft veins as one of the materials for closing nerve ends is advantageous owing to its affordability and versatility in accommodating nerves of varying sizes.