Use of Vascularized, Denervated Muscle Targets for Prevention and Treatment of Upper-Extremity Neuromas

Visakha Suresh; Eliana J Schaefer; Nicholas A Calotta; Aviram M Giladi; Sami H Tuffaha

doi:10.1016/j.jhsg.2022.06.001

Use of Vascularized, Denervated Muscle Targets for Prevention and Treatment of Upper-Extremity Neuromas

J Hand Surg Glob Online. 2022 Jul 3;5(1):92-96. doi: 10.1016/j.jhsg.2022.06.001. eCollection 2023 Jan.

Authors

Visakha Suresh¹, Eliana J Schaefer^{2

3}, Nicholas A Calotta¹, Aviram M Giladi², Sami H Tuffaha^{1

2}

Affiliations

¹ Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
² The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
³ Department of Orthopedics, Georgetown University School of Medicine, Washington, DC.

Abstract

Purpose: Neuroma formation following upper-extremity peripheral nerve injury often results in persistent, debilitating neuropathic pain with a limited response to medical management. Vascularized, denervated muscle targets (VDMTs) offer a newly described surgical approach to address this challenging problem. Like targeted muscle reinnervation and regenerative peripheral nerve targets, VDMTs are used to redirect regenerating axons from an injured nerve into denervated muscle to prevent neuroma formation. By providing a vascularized muscle target that is reinnervated via direct neurotization, VDMTs offer some theoretical advantages in comparison with the other contemporary surgical options. In this study, we followed the short-term pain outcomes of patients who underwent VDMT surgery for neuroma prevention or treatment.

Methods: We performed a retrospective chart review of 9 patients (2 pediatric and 7 adult) who underwent VDMTs either for symptomatic upper-extremity neuromas or as a prophylactic measure to prevent primary neuroma formation. In-person and/or telephone interviews were conducted to assess their postoperative clinical outcomes, including the visual analog pain scale simple pain score.

Results: Of the 9 patients included in this study, 7 underwent VDMT surgery as a prophylactic measure against neuroma formation, and 2 presented with symptomatic neuromas that were treated with VDMTs. The average follow-up was 5.6 ± 4.1 months (range, 0.5-13.2 months). The average postoperative pain score of the 7 adult patients was 1.1 (range, 0-8).

Conclusions: This study demonstrated favorable short-term outcomes in a small cohort of patients treated with VDMTs in the upper extremity. Larger, prospective, and comparative studies with validated patient-reported and objective outcome measures and longer-term follow-ups are needed to further evaluate the benefits of VDMTs in upper-extremity neuroma management and prevention.

Type of study/level of evidence: Therapeutic III.

Keywords: Neuromas; Peripheral nerve injuries; Regenerative peripheral nerve interface; Targeted muscle reinnervation; Vascularized denervated muscle targets.