scholarly journals 933 The Glass Half Full? A Case Of Cutaneous Neuroma Formation Post Laceration Of First Web-Space Of The Hand

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Barzilai ◽  
G Smith
Keyword(s):  
Peripheral Nerve Injury ◽  
Severe Pain ◽  
Cutaneous Lesion ◽  
Penetrating Trauma ◽  
Nerve Graft ◽  
Digital Nerve ◽  
Penetrating Injuries ◽  
Reduce Risk ◽  
Web Space ◽  
Neuroma Formation

Abstract Introduction neuromas are lesions resulting from abnormal nerve regeneration following a peripheral nerve injury and may cause severe pain. Method we present a case of a 54-year-old female who developed a painful cutaneous lesion over the first web-space of the hand following an untreated glass laceration 3 years previously. Results surgical resection revealed a 100% transection of ulnar digital nerve (UDN) of thumb with regeneration into the skin. A posterior interosseous nerve (PIN) nerve graft was required to bridge the resulting 15mm gap. Histopathology revealed a 12x12mm neuroma extending into dermis. Conclusions cutaneous neuroma is a rare consequence of penetrating trauma. This case highlights the need for prompt assessment of penetrating injuries to reduce risk of neuroma formation.

scholarly journals Isolated Intermetatarsal Ligament Release as Primary Surgical Management for Morton’s Neuroma

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mohamed Abdelaziz ◽  
Kathryn Whitelaw ◽  
Gregory Waryasz ◽  
Daniel Guss ◽  
Anne Johnson ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Transection ◽  
Digital Nerve ◽  
Morton’S Neuroma ◽  
The Past ◽  
Symptom Exacerbation ◽  
Morton's Neuroma ◽  
Web Space ◽  
Neuroma Formation

Category: Midfoot/Forefoot Introduction/Purpose: While the precise pathoetiology of Morton’s neuroma remains unclear, nerve inflammation as a result of chronic entrapment from the overlying intermetatarsal ligament (IML) may play a role. Traditional surgical management involved common digital nerve transection with neuroma excision, but this procedure risks unpredictable formation of a stump neuroma and potential worsening of symptoms. Accordingly, the senior author has over the past six years espoused isolated IML release and common digital nerve decompression in lieu of nerve transection or neuroma excision as an alternative treatment strategy. We hypothesized that IML release offers effective pain relief and high patient satisfaction level as a surgical treatment for recalcitrant Morton’s neuroma without the risk of stump neuroma formation or symptom exacerbation. Methods: Medical records for all consecutive patients treated surgically with isolated single interspace IML release for symptomatic and recalcitrant Morton’s neuroma over a four year period at a large academic medical center were examined. Any adult patient with clinically diagnosed Morton’s neuroma who had failed at least three months of conservative treatment and who then underwent single-webspace IML decompression were included. Any patient who had less than three months postoperative follow up, had undergone revisional neuroma surgery, or had undergone additional procedures at the time of the IML release were excluded. Overall patient satisfaction as well as pre- and post-operative Visual Analog Pain Scale (VAS) assessments were recorded for all patients. Results: Eleven patients underwent isolated, single interspace IML decompression for Morton’s neuroma over this time frame. One of these patients had a neuroma localized to the second web space and 10 were localized to the third web space. Average follow-up was 10.8± 9 (3-32) months (Table 1). VAS pain scores averaged 6.4 ± 1.9 (4-9) preoperatively and decreased to an average of 1.5 ± 1.6 (0-5) at final follow up (P = 0.003). All patients reported significant pain improvement and an overall satisfaction with the procedure (would undergo it again). No patients returned to the operating room, there were no postoperative infection nor worsening of pain, and no other complications were reported. Conclusion: Isolated single interspace IML release of chronically symptomatic Morton’s neuroma shows promising short-term results regarding pain relief and overall patient satisfaction, with few complications and no demonstrated risk of recurrent neuroma formation, permanent numbness, or postoperative symptom exacerbation. The authors’ collective experience with this approach has been positive enough over the past six years to result in the entire abandonment of the practice of neuroma excision in this patient population.

Digital Nerve Grafting Using the Dorsal Sensory Branch of the Ulnar Nerve

1985 ◽  
Vol 10 (1) ◽  
pp. 37-40 ◽  
Author(s):  
T. L. GREENE ◽  
J. B. STEICHEN
Keyword(s):  
Ulnar Nerve ◽  
Hand Function ◽  
Nerve Graft ◽  
The Other ◽  
Nerve Grafting ◽  
Digital Nerve ◽  
Nerve Grafts ◽  
Neuroma Formation

The dorsal sensory branch of the ulnar nerve has been found to have the appropriate size and sufficient length for use as a digital nerve graft. This donor nerve was utilised fifteen times in twelve patients for the bridging of defects in thirteen digital nerves of the fingers. After an average follow-up of 23.2 months, only one patient failed to achieve any two point discrimination in the area supplied by the involved digital nerve. The other eleven patients had an average two point discrimination of 9.5 mm with a range of 5 to 18 mm. Painful neuroma formation or loss of hand function related to the use of the dorsal sensory branch of the ulnar nerve as a donor for digital nerve grafts was not encountered.

Digital Nerves of the Foot: Anatomic Variations and Implications Regarding the Pathogenesis of Interdigital Neuroma

Foot & Ankle ◽  
1993 ◽  
Vol 14 (4) ◽  
pp. 208-214 ◽  
Author(s):  
Kenneth A. Levitsky ◽  
Benjamin A. Alman ◽  
David S. Jevsevar ◽  
James Morehead
Keyword(s):  
Digital Nerve ◽  
Morphometric Data ◽  
Lateral Plantar Nerve ◽  
The Third ◽  
Communicating Branch ◽  
Mechanical Basis ◽  
The Common ◽  
Web Space ◽  
Neuroma Formation ◽  
Communicating Branches

Seventy-one cadaveric feet were dissected, with attention to communicating branches of the digital nerves, the diameters of the digital nerves, the distance between the metatarsal heads, and the presence or absence of interdigital neuromas. A communicating branch was absent in 52 feet (73.2%) and present in 19 specimens (26.8%). The communication was from the fourth to the third web space common digital nerve (i.e., from the lateral to the medial plantar nerve) in 11 specimens. A reverse communication, from the third to the fourth web space common digital nerve (i.e., from the medial to the lateral plantar nerve), was present in eight specimens. Neuromas were identified in the second web space in 26 specimens and in the third web space in 32 feet. The common digital nerve to the third web space was not thicker in feet with a contribution from the fourth to the third web space nerve. Additionally, the incidence of third web space neuroma in feet with this type of communication was not significantly greater than in those feet without an internervous communication. However, the intermeta-tarsal head distances and the ratios of the intermetatarsal head distance to the digital nerve diameter in web spaces 2 and 3 were significantly smaller in comparison to spaces 1 and 4 ( P < .05). The morphometric data lend support to theories that explain the propensity for neuroma formation in both the second and third web spaces on a mechanical basis. The data do not support those theories that explain an increased incidence of third web space neuroma formation based on a communication from the fourth to the third web space digital nerve.

scholarly journals PENETRATING TRAUMA OF BRACHIOCEPHALIC ARTERY LESION WITH EMBOLIZATION OF FOREIGN BODY TO RIGHT AXILLARY ARTERY IN PEDIATRIC PATIENT: CASE PRESENTATION AND HIS MANAGEMENT.

2020 ◽  
Author(s):  
Luis Zerpa Acosta ◽  
Jameel Al Ata ◽  
Alfredo Sanchez Gamboa ◽  
Elmahi Babikir ◽  
Abdullah Al Zahrani ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Surgical Repair ◽  
Axillary Artery ◽  
Median Sternotomy ◽  
Penetrating Trauma ◽  
Innominate Artery ◽  
Penetrating Injuries ◽  
Patient Case ◽  
Case Presentation ◽  
Great Vessels

ABSTRACT: BACKGROUND: Penetrating injuries of the intrathoracic great vessels are well recognized although uncommon in pediatric patients, management in pediatric patients presents challenges. Surgical repair by median sternotomy is the exposure of choice for accessing innominate artery injuries, but endovascular intervention in being increasingly introduced in the hemodynamically stable

scholarly journals Functional Recovery via Preregenerated Nerve Graft in Rat Sciatic Nerve Injury Model

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Umang Khandpur ◽  
Ying Yan ◽  
Wilson Zachary Ray ◽  
Matthew R MacEwan
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Functional Recovery ◽  
Peripheral Nerve Injury ◽  
Muscle Force ◽  
Nerve Graft ◽  
Tissue Loss ◽  
Limb Amputation ◽  
Percent Recovery

Abstract INTRODUCTION Patients who have experienced major tissue loss with peripheral nerve injury (eg, limb amputation) may be offered composite tissue allotransplantation (CTA). The return of sensory ability and cosmetic component of CTAs make them an attractive alternative to prosthetic devices. Unfortunately, robust reinnervation especially over great distances remains an issue for hand allotransplants. In this study, we introduce a preregenerated nerve graft to shorten the distance and therefore time to terminal tissue reinnervation, which could improve the utility of CTAs. METHODS A total of 18 rats weighing 250 to 300 gm each were randomized into 1 of 3 groups: baseline, fresh, or preregenerated. The baseline group underwent sham surgery to obtain baseline functional data. The fresh and preregenerated groups both underwent grafting of the sciatic nerve but the preregenerated group utilized 8-wk preregenerated grafts. At postperative week 8 from distal neurorrhaphy, both groups underwent terminal functional testing via EMG and evoked muscle force. RESULTS The preregenerated group had significantly greater mean EMG (P < .05) and maximum tetanic muscle force values (P < .05) than the fresh group. Mean percent recovery in EMG for the fresh group was 21.95% compared with 81.79% in the preregenerated group. Mean percent recovery in muscle force was 9.46% and 33.15%, respectively. CONCLUSION The results of this study provide a novel approach to enhance final functional recovery after peripheral nerve injury. The current practice of constructing a nerve stump may be improved by grafting a nerve segment at the time of injury and allowing it to preregenerate into local musculature so that if a CTA is later performed, an expedited and more robust reinnervation could be accomplished.

Pencils and Pens: An Under-Recognized Source of Penetrating Injuries in Children

2011 ◽  
Vol 77 (8) ◽  
pp. 1076-1080
Author(s):  
Sarah B. Fisher ◽  
Matthew S. Clifton ◽  
Amina M. Bhatia
Keyword(s):  
Trauma Registry ◽  
Recent Literature ◽  
Surgical Intervention ◽  
Case Reports ◽  
Penetrating Trauma ◽  
Pediatric Hospital ◽  
Penetrating Injuries ◽  
Hospital System ◽  
Potential Risks ◽  
Home And School

Unlike other sharp objects, pens and pencils are readily available to children both at home and school. Although case reports are published, no series of pen or pencil injuries have been reported in the recent literature. We therefore reviewed the incidence and injury profiles of writing instruments as compared with other sources of penetrating trauma. The trauma registry from a large urban pediatric hospital system was queried for nonmissile, nonbite penetrating injuries from 2005 through 2009. Retrospective data was collected on demographics, injuries, operations, admissions, and mortalities. Additionally, data regarding pen and pencil injuries from 2009 to 2010 were collected prospectively, and one case from 2003 was included retrospectively. Fourteen injuries from writing instruments were seen and involved the head and neck (9), chest (1), bladder/perineum (2), and extremities (2). Eleven children were admitted and eight required surgical intervention. One child died from a transhemispheric brain injury after intraorbital penetration by a pencil. Penetrating trauma from writing instruments is not an uncommon source of injury and often requires surgical intervention to remove the object. Injuries from pens and pencils can be severe or even fatal. Appropriate parent and teacher education regarding the potential risks may help to prevent such injuries.

Reconstruction of Proper Digital Nerve Defects in the Thumb Using a Pedicle Nerve Graft

2012 ◽  
Vol 130 (5) ◽  
pp. 1089-1097 ◽  
Author(s):  
Chao Chen ◽  
Peifu Tang ◽  
Xu Zhang
Keyword(s):  
Nerve Graft ◽  
Digital Nerve

scholarly journals Differences in Characteristics and Outcome of Patients with Penetrating Injuries in the USA and the Netherlands: A Multi-institutional Comparison

2018 ◽  
Vol 42 (11) ◽  
pp. 3608-3615 ◽  
Author(s):  
Suzan Dijkink ◽  
Pieta Krijnen ◽  
Aglaia Hage ◽  
Gwendolyn M. Van der Wilden ◽  
George Kasotakis ◽  
...  
Keyword(s):  
Length Of Stay ◽  
The Netherlands ◽  
Hospital Mortality ◽  
Penetrating Trauma ◽  
Admission Rate ◽  
Population Characteristics ◽  
Penetrating Injuries ◽  
Icu Length Of Stay ◽  
Revised Trauma Score ◽  
The Usa

AbstractIntroductionThe incidence and nature of penetrating injuries differ between countries. The aim of this study was to analyze characteristics and clinical outcomes of patients with penetrating injuries treated at urban Level-1 trauma centers in the USA (USTC) and the Netherlands (NLTC).MethodsIn this retrospective cohort study, 1331 adult patients (470 from five NLTC and 861 from three USTC) with truncal penetrating injuries admitted between July 2011 and December 2014 were included. In-hospital mortality was the primary outcome. Outcome comparisons were adjusted for differences in population characteristics in multivariable analyses.ResultsIn USTC, gunshot wound injuries (36.1 vs. 17.4%,p < 0.001) and assaults were more frequent (91.2 vs. 77.7%,p < 0.001). ISS was higher in USTC, but the Revised Trauma Score (RTS) was comparable. In-hospital mortality was similar (5.0 vs. 3.6% in NLTC,p = 0.25). The adjusted odds ratio for mortality in USTC compared to NLTC was 0.95 (95% confidence interval 0.35–2.54). Hospital stay length of stay was shorter in USTC (difference 0.17 days, 95% CI −0.29 to −0.05,p = 0.005), ICU admission rate was comparable (OR 0.96, 95% CI 0.71–1.31,p = 0.80), and ICU length of stay was longer in USTC (difference of 0.39 days, 95% CI 0.18–0.60,p < 0.0001). More USTC patients were discharged to home (86.9 vs. 80.6%,p < 0.001). Readmission rates were similar (5.6 vs. 3.8%,p = 0.17).ConclusionDespite the higher incidence of penetrating trauma, particularly firearm-related injuries, and higher hospital volumes in the USTC compared to the NLTC, the in-hospital mortality was similar. In this study, outcome of care was not significantly influenced by differences in incidence of firearm-related injuries.

Centrocentral Anastomosis with Autologous Nerve Graft Treatment of Foot and Ankle Neuromas

1996 ◽  
Vol 17 (2) ◽  
pp. 85-88 ◽  
Author(s):  
Cobi Lidor ◽  
Reginald L. Hall ◽  
James A. Nunley
Keyword(s):  
Peroneal Nerve ◽  
Autologous Transplantation ◽  
Nerve Graft ◽  
Superficial Peroneal Nerve ◽  
Foot And Ankle ◽  
Morton’S Neuroma ◽  
Gun Shot ◽  
Morton's Neuroma ◽  
Web Space ◽  
Objective Improvement

Painful neuromatas in the foot and around the ankle can be difficult to treat. Five patients of clinically and histologically proven neuromas underwent centrocentral union with autologous transplantation. Three patients had previous toe amputations involving multiple operations. One patient had failed multiple operative treatments for Morton's neuroma in his 3rd web space. One patient had a neuroma in his superficial peroneal nerve caused by a gun shot wound. All patients but one showed definitive subjective and objective improvement after centrocentral union with the interposed autologous nerve graft. The patient with “recurrent” Morton's neuroma had the least improvement. This technique can be recommended as an alternative for the prevention of painful stump neuromata.

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