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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2023; 08(01): e60-e65
DOI: 10.1055/a-2039-1193
Case Report

Successful Treatment of a Painful Neuroma Using Fascicular Shifting in the Ulnar Nerve: A Case Report

Laura A. Hruby   *
1   Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
2   Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
,
Matthias E. Sporer   *
2   Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
,
Irena Krusche-Mandl
1   Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
Vlad Tereshenko
2   Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
,
Hannes Platzgummer
3   Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
,
Stefan Hajdu
1   Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
Oskar C. Aszmann
2   Clinical Laboratory for Bionic Extremity Reconstruction, Medical University of Vienna, Vienna, Austria
4   Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
› Author Affiliations Funding This study was funded by a grant from the European Research Council under the European Union's Horizon 2020 research and innovation program (grant agreement no. 810346) and by the Christian Doppler Research Foundation of the Austrian Council for Research and Technology Development. None of the funding agencies were involved in the collection, analysis, and interpretation of data or writing and publication of this article.
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Abstract

Objective We report the case of a 40-year-old man with an inveterate ulnar nerve neuroma following a laceration injury of his left wrist twenty-three years ago. The patient presented with a typical ulnar claw-hand deformity and debilitating neuropathic pain in his hand (VAS 8.4). Pre-operative imaging revealed a neuroma of the ulnar nerve at the Guyon's canal. Moreover, a complete atrophy of all intrinsic hand muscles innervated by the ulnar nerve was present.

Methods A Zancolli lasso procedure was performed to reduce the clawing effect. The neuroma was resected producing a nerve defect of five centimeters. Since the injury dated back more than two decades and any motor recovery was deemed impossible at that point, the motor fascicle of the ulnar nerve, i.e. the deep branch, was selectively neurolysed and harvested as an autologous nerve graft. Then the graft was shifted into the defect to be coapted with the superficial branch fascicle in an end-to-end fashion.

Results The presented fascicular shift procedure resulted in satisfying and sustained pain reduction. At the six-month follow-up, the VAS decreased to 1.2, and two years post-operatively, the patient reported 2.5 on the VAS.

Conclusion The fascicular shift procedure offers an alternative approach to conventional nerve grafts. If nerve grafting is required, using a locally harvested graft avoids additional donor site morbidity. Assuming the clinical scenario allows for fascicular grafting, we strongly suggest considering the fascicular shift procedure as a cost-effective alternative to expensive conduits and processed nerve allografts in sensory nerve reconstruction.

Keywords

neuropathic pain - neuroma treatment - nerve reconstruction

* These authors contributed equally to this work and retain the first authorship.




Publication History

Received: 09 July 2022

Accepted: 21 November 2022

Accepted Manuscript online:
20 February 2023

Article published online:
23 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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