| Management of the Posttraumatic Neuralgia of the Peripheral Nerve by External Neurolysis |
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Hyeok Rhyou, Bo Gun Suh, Chaeik Chung, Kyung Chul Kim |
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Upper Extremity and Microsurgery Center, Department of Orthopedic Surgery, Semyeong Christianty Hospital, Pohang, Kyeongbuk, Korea. inhyeok_r@yahoo.co.kr |
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| Abstract |
Purpose
To evaluate the results of the external neurolysis of the scarred peripheral nerves present with the posttraumatic neuralgia refractory to the conservative treatment for at least 6 months with or without vein wrapping and/or free fat graft to prevent scar reformation.
MATERIALS AND METHODS: In 8 patients with posttraumatic neuralgia of the peripheral nerve unresponsive to conservative treatment for at least 6 months, only neurolysis was done in 6 cases. Vein wrapping with free fat graft was concomitantly added after neurolysis in one case and free fat graft was added in the other case. The inclusion criteria were neuralgia felt anatomically along the affected nerve, positive Tinel sign at the scarred site and aggravation of pain with passive motion of the adjacent joint. Affected were digital nerves (two cases), ulnar nerve at the wrist (one case), median nerve (one case), peroneal nerve around knee (one case), posterior tibial nerves (two cases) and plantar nerve (one case). Patients were assessed for the disappearance of neuralgia and Tinel sign and subjective satisfaction with VAS (no pain, 0 and no change or aggravated, 10 compared to contra-lateral side) RESULT: Neuralgia was absent in four cases and persisted in four cases. Average VAS was 5.8 (0~10). According to the degree of the scarred surroungings, neuralgia was persisted after only neurolysis in four cases of the severely scarred 5 cases, but in one case having free fat graft added, neuralgia was absent. In partially scarred two cases, neurolysis with or without additional procedures (free fat graft and vein wrapping) brought the same result of VAS. In one case of good surroundings, neuralgia was absent after neurolysis. Tinel sign was absent in 4 cases where neuralgia had disappeared.
Conclusion
Prevention of re-adhesion after neurolysis seems to be very important to yield good results. Vein wrapping and/or free fat grafting may be effective methods to be applicable if the adjacent tissue looks scarred |
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