Traditional Neuroma Management Strategies: A Systematic Review.

Background: In this systematic review, the authors discuss traditional management strategies of neuromas. Surgical management can be described as either passive and ablative or active and reconstructive. Our aim was to evaluate the evidence supporting traditional management strategies in patients affected by neuromas.

Methods: The systematic literature search was conducted in PubMed/MEDLINE databases using search terms related to neuromas and their surgical management. Studies involving targeted muscle reinnervation or regenerative peripheral nerve interface were excluded. Two reviewers selected the studies, evaluated their methodological quality, and retrieved data independently. This review was conducted in a manner consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Selected studies were analyzed for pain and functional outcomes.

Results: A total of 1064 articles were identified, and 22 studies were selected for review. Passive or ablative modalities for treatment of neuromata include excision of neuroma, excision with implantation into adjacent tissue, nerve caps, vein cap, and relocation nerve grafting. Active or reconstructive modalities that allow for nerve regeneration include hollow tube reconstruction, reconstruction with an allograft, and centrocentral nerve anastomosis.

Conclusions: Passive treatment modalities can offer reliable pain relief in appropriately selected patients but do not allow for nerve regeneration. As such active, reconstructive modalities should be used when possible.