Vlot, M.A. (Margot) (2016) Incidence of painful neuroma in patients with digital amputations. thesis, Medicine.
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Abstract
A neuroma is a bulbous growth or tumor of nerve tissue. After a peripheral nerve is severed in amputation injuries, formation of a neuroma is inevitable. Development of painful neuroma after traumatic digital amputation can be debilitating, limiting overall limb function. Specific prognostic factors that predispose an individual to formation of painful neuroma have not been described. In this study, we aimed to study the incidence of painful neuroma in patients with traumatic, digital amputations and the revision rate for surgery. We hypothesized that there are no factors independently associated with development of painful neuroma after traumatic digital amputation. We retrospectively identified 1,083 patients who underwent revision amputation for traumatic amputation injury of one or more digits. We recorded patients’ demographic information, details on injury and treatment and we recorded if the patients returned with symptomatic neuroma. For neuroma patients, we recorded details on the treatment for neuroma symptoms. We found 71 patients (6.6%) with painful neuroma at follow up, with a mean time to presentation with neuroma symptoms of 6.9 months after the initial amputation procedure. Forty-seven patients underwent surgery for painful neuroma (66%) with a mean time to revision surgery of 12 months. Eleven patients had a recurrent symptomatic neuroma (15%) and 3 patients had a secondary recurrence of painful neuroma (4.2%). In multivariable logistic regression analysis, we found that amputation injury of the index finger and avulsion injury are independently associated with higher odds of developing painful neuroma. We believe that an initial approach with desensitization and hand therapy is warranted for all patients with neuroma pain, and those patients with persistent or debilitating symptoms may be a candidate for surgical intervention.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Kallenberg, Prof. dr. C.G.M. |
| Supervisor name: | External supervisor: and Wilkens, Suzanne C. MD and Institution: Massachusetts General Hospital, Orthopaedic Han and Service and Location: Boston, Massachusetts |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2454 |
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