1259 Clinical Outcomes of Vascularised Versus Free Regenerative Peripheral Nerve Interface in Upper Limb Neuromas: A Systematic Review

Abstract

Abstract Aim To compare clinical outcomes of vascularised regenerative peripheral nerve interface (vRPNI) versus free regenerative peripheral nerve interface (fRPNI) in upper limb neuromas. Method A systematic review on upper limb neuromas treated with either fRPNI or vRPNI was performed in October 2022 in accordance with the PRISMA 2020 guidelines. A PubMed search using the term “RPNI” was performed. Only papers with clinical results from patients who had undergone either fRPNI or vRPNI to the upper limb were included; review and laboratory papers were excluded. Patient and clinical data collected include the underlying aetiology, time interval to RPNI procedure, as well as mean patient age, post-operative follow-up period and neuroma pain score reduction. Results Of 43 papers identified, only four papers fulfilled the inclusion criteria. This provided data for upper limb neuromas in 32 patients where a total of 83 RPNIs (22 vascularised) were performed (43 prophylactically). The means for patient age, duration of neuroma pain, length of reported post-operative follow-up, and reduction in neuroma pain scores were 44.0 years, 1.4 years, 12.2 months and 51.3% respectively. Conclusions The currently available data support the use of both fRPNI and vRPNI for the treatment of upper extremity neuromas, both after the development of symptoms and prophylactically at the time of surgery, despite the heterogeneity and inconsistencies in data reporting. Further studies are required in the form of randomised control trials to assess for the superiority (or not) of fRPNI versus vRPNI.