June 2019 #PRSJournalClub Wrap-Up: Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery

by Zeshaan N. Maan, MD, MSc
Plastic Surgery Resident
Stanford University

The June edition of #PRSJournalClub provided an excellent discussion of an important patient safety PRS article entitled “Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery” by Wolvetang, Lans, Verhiel, Notermans, Chen and Eberlin. The #PRSJournalClub discussion, which enabled a broad audience to ask questions and interact directly with the authors, can be found on the #PRSJournal Facebook page. The article can be found here

In the study, Wolvetang et al. evaluate the recurrence rates and need for secondary surgery after management of symptomatic neuroma with various surgical approaches. Their retrospective analysis demonstrates significantly reduced rates of secondary surgery when neuroma excision was accompanied by neurorrhaphy, with or without nerve graft, compared to excision alone or implantation into bone or muscle. Their analysis also identifies extremities as the predominant region where neuromas occur. This study is particularly important as excision and implantation was found to be both the most commonly performed and least effective primary technique. The authors also review the literature, which supports the benefits of neurorraphy in the treatment of neuroma. They also highlight the benefits of targeted muscle reinnervation and creation of regenerative peripheral nerve interfaces during the intial amputation in preventing neuroma formation. These findings should inform a change in practice for all plastic surgeons treating patients with neuroma with the caveat that this is a retrospective study.

The article was first discussed on the PRS Podcast with special guest moderator Paul Cederna, MD. Listen to the podcast discussion below:

An engaging and thought-provoking online discussion also took place on the #PRSJournal Facebook page over a two-day period, where established plastic surgeons and residents were able to ask questions, and get answers from the authors of the article themselves!

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook! 



This June #PRSJournalClub article (as well as other Journal Club selections from June), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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