Symptomatic Neuroma following Revision Amputation for Traumatic Digital Amputation

Abstract

Consulting Fee: Miami Device Solutions (Chen) Speakers Bureau: Dupuy-Mitek (Chen) Contracted Research: Axogen (Eberlin) We assessed 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. We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation. Patients undergoing replantation or revascularization as initial treatment were excluded. We studied the incidence of painful neuromas and the rate of neuroma surgery and performed multivariable logistic regression analysis to identify factors independently associated with painful neuroma and neuroma surgery. Seventy-one of 1083 patients (6.6%) reported a symptomatic neuroma. Mean time to diagnosis was 6.4 months. Forty-seven patients (66%) underwent surgery for painful neuroma. Eleven patients had a recurrent, symptomatic neuroma (15%) after secondary surgery and three patients had recurrence of painful neuroma (4.2%). Mean time to surgical intervention was 11 months. Index finger injury and avulsion mechanism were associated with higher odds of symptomatic neuroma (P < 0.05). (Figure 51-1, Table 51-1) •Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic distal upper extremity amputation.•More than half of these patients will undergo revision surgery for neuroma with a mean time to operative intervention of 11 months.Table 51-1Multivariable Logistic Regression Analysis (n = 1,077*)Odds ratio (95% confidence interval)Standard errorP valueAge0.99 (0.97 to 1.0)0.00870.12Workers’ compensation1.6 (0.83 to 3.1)0.530.16Type of injury SharpReference Crush1.5 (0.83 to 2.6)0.420.18 Avulsion2.6 (1.2 to 5.4)0.960.011 Burn0.90 (0.10 to 7.7)0.990.92 Blast1.4 (0.17 to 12)1.60.74Amputated digit Index finger2.2 (1.2 to 3.8)0.620.0080 Ring finger1.7 (0.89 to 3.2)0.550.11Level of amputation Proximal phalanx1.4 (0.80 to 2.4)0.390.24Multiple digits affected1.3 (0.66 to 2.4)0.480.48*6 patients were excluded due to unknown values for type of injury Open table in a new tab *6 patients were excluded due to unknown values for type of injury