Symptomatic Neuroma following Revision Amputation for Traumatic Digital Amputation
Margot A. Vlot, BSc; Suzanne Caroline Wilkens, MD; Neal C. Chen, MD; Kyle R Eberlin, MD
Massachusetts General Hospital, Boston, MA
Introduction: To assess the incidence of painful neuroma in patients with traumatic distal upper extremity amputations and the revision rate for surgery following initial treatment. We tested the null hypothesis that there are no factors independently associated with the development of symptomatic neuroma after traumatic digital amputation.
Materials & Methods: A retrospective review was performed of 1,083 patients who underwent revision amputation for traumatic digital amputation; those undergoing replantation or revascularization were excluded. Patients who developed a painful neuroma during follow up were identified with a minimum follow-up of one week and median follow-up of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development.
Results: Seventy-one of 1083 patients (6.6%) developed symptomatic neuroma. Mean time to diagnosis was 6.4 months. Forty-seven patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index finger injury and avulsion injury mechanism were significantly associated with a higher risk of symptomatic neuroma.
Conclusions: Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation, and more than half of these patients will undergo revision surgery for neuroma with a mean time to operative intervention of 11 months.
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