Perineural fat grafting in end-neuroma pain treatment: long-term outcomes

Abstract

Peripheral painful end-neuromas decrease quality of life significantly. Drug-resistant painful neuromas often require surgical treatment, nevertheless there is no actual gold standard. We retrospectively analyzed 26 patients suffering from painful end-neuromas treated with neuroma excision followed by the perineural fat grafting (PFG). We evaluated the improvement in pain, disability, and quality of life on the long term.All patients were referred to our department between 2009 and 2017. “Visual analogue scale (VAS)”; “disability of the arm, shoulder, and hand (DASH)”; and “World Health Organization Quality of Life (WHOQOL) index” were systematically scored before each surgical intervention and re-evaluated after 24 months. The majority of neuromas were traumatic (n. 16; 62%) and involved the upper extremity (n. 21; 81%). Eight patients (31%) had already received a previous neuroma excision. After the neuroma excision followed by the PFG, pain decreased 4 points in the VAS scale on average (p < 0.001); disability improved 15 points in the DASH questionnaire (p < 0.001); the quality of life significantly improved in every WHOQOL index domain. Neuroma excision with PFG appeared equally effective both on patients with a primary or a relapsing neuroma. Neuromectomy with perineural fat grafting is a simple, accessible, and effective technique in end-neuroma pain treatment, owning a low surgical risk and minimal donor site morbidity. Level of evidence: Level III, therapeutic Study.