PREVENTION OF SYMPTOMATIC NEUROMA BY USING SYNTHETIC CONDUITS IN FINGER AMPUTATION STUMPS

WATAYA, ERICK YOSHIO; LOPES, DEBORAH BERNARDO; TAKAZONO, DIOGO KENZO; PESSA, MARIANA MIRANDA NICOLOSI; RUSIG, RENATO POLESE; SORRENTI, LUIZ; TORRES, LUCIANO RUIZ; WEI, TENG HSIANG; REZENDE, MARCELO ROSA DE; MATTAR JUNIOR, RAMES

doi:10.1590/1413-785220243201e283207

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ORIGINAL ARTICLE / WRIST AND HAND • Acta ortop. bras. 33 (spe1) • 2025 • https://doi.org/10.1590/1413-785220243201e283207 linkcopy

PREVENTION OF SYMPTOMATIC NEUROMA BY USING SYNTHETIC CONDUITS IN FINGER AMPUTATION STUMPS

PREVENÇÃO DE NEUROMA SINTOMÁTICO PELO USO DE CONDUÍTES SINTÉTICOS EM COTOS DE AMPUTAÇÃO DE DEDOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: Compare the formation of symptomatic neuromas in patients submitted to digital amputations, with and without nerve conduits (Neurolac^® ), and sensitivity return.

Methods: Prospective, case-control study, including 14 patients with digital amputations (total of 17 fingers) whose conduits were used on the ulnar or radial side, while the contralateral side was used in the same patients as control. The Tinel test, Semmes-Weinstein monofilament, and two-point discrimination tests were evaluated at one week, two weeks, one month, three months, and six months postoperatively.

Results: Using nerve conduits (Neurolac^®) in digital nerve amputation stumps had statistical significance (p = 0.04) in preventing pain due to symptomatic neuroma at the end of six months after digital regularization.

Conclusion: There is a favorable trend towards using conduits as prophylaxis of symptomatic neuroma formation since the nerves in which they were used showed fewer clinical signs of neuroma formation six months after surgery. Level of evidence II, Prospective comparative study.

Keywords:
Amputation; Traumatic; Fingers; Neuroma; Nerve Conduit; Sensory Recovery

Outcome	Description	Example
Negative	Tinel sign lower than in contralateral nerve	Tinel sign of the case group lower than the control group
Positive	Tinel sign equal to or greater than in contralateral nerve	Equal positive Tinel sign between case and control

Procedure	Occurrence	%
Thumb regularization in IF	2	11.8%
Thumb regularization in FP	1	5.9%
Thumb regularization in MCF	1	5.9%
Regularization of the second finger in FD	1	5.9%
Regularization of the second finger in FP	4	23.3%
Regularization of the second finger in IFP	1	5.9%
Regularization of the second finger in IFP	2	11.8%
Regularization of the second finger in FP	1	5.9%
Regularization of the fourth finger in FM	2	11.8%
Regularization of the fourth finger in IFP	1	5.9%
Regularization of the fifth finger in IFP	1	5.9%

	Follow-up period										Last valid data (n = 34)
	1 week (n = 28)		2 weeks (n = 24)		1 month (n = 18)		3 months (n = 16)		6 months (n = 8)		Last valid data (n = 34)
Conduit use	n (%)	p*	n (%)	p*	n (%)	p*	n (%)	p*	n (%)	p*	n (%)	p*
Yes	14 (100%)	0.31	10 (83.3%)	0.15	5 (55.5%)	0.18	6 (75.0%)	1.00	0 (0%)	0.04	12 (70.6%)	0.25
No	13 (92.9%)	0.31	12 (100%)	0.15	8 (88.9%)	0.18	6 (75.0%)	1.00	4 (100%)	0.04	15 (88.2%)	0.25

	Follow-up period						Last valid data
	1 month		3 months		6 months		Last valid data
Conduit use	Median	p*	Median	p*	Median	p*	Median	p*
Conduit use	(min - max)	p*	(min - max)	p*	(min - max)	p*	(min - max)	p*
Yes	0.20	0.63	0.20	0.54	0.20	0.31	0.05	0.19
Yes	(0.05 - 0.20)		(0.05 - 0.20)		(0.05 - 0.20)		(0.05 - 0.2)
No	0.20		0.05		0.05		0.05
No	(0.05 - 4.0)		0.05		(0.05 - 0.05)		(0.05 - 4.0)

	Follow-up period						Last valid data
	1 month (n = 14)		3 months (n = 7)		6 months (n = 4)		Last valid data
Conduit use	Median	p*	Median	p*	Median	p*	Median	p*
Conduit use	(min-max)	p*	(min-max)	p*	(min-max)	p*	(min-max)	p*
Yes	4.5	0.94	5.0	0.93	3.5	0.84	4.0	0.93
Yes	(0 - 9.0)		(1.0 - 9.0)		(1.0 - 8.0)		(0 - 10)
No	6.0		3.0		2.5		3.0
No	(0 - 10.0)		(0 - 9.0)		2.0		(0 - 9.0)

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[TFN1] FP: proximal phalanx; FM: middle phalanx; FD: distal phalanx; MCF: metacarpal phalangeal joint; IFP: proximal interphalangeal joint; IFD: distal interphalangeal joint; IF: interphalangeal joint of the thumb.