Challenges in the surgical treatment of neuroma in continuity in the upper extremity using human acellular nerve allografts

The restoration of nerve function after the injury might be complicated by the development of a disorganized fibrous mass-a neuroma. This results in sensory and/or motor deficits and pain that can be severely debilitating. Surgical excision of the painful neuroma may leave a gap, which can be bridged using autografts or allografts. The main objectives of this study were to obtain 1-year clinical results in patients who underwent excision and reconstruction of a painful neuroma in continuity using decellularized allografts after nerve lesions in the upper extremity. In a prospective cohort study, we evaluated 21 consecutive patients. The patients were evaluated for pain, motor, and sensory function of the hand as well as with patient-reported outcomes. The results showed meaningful sensory recovery in 47% (≥S3), persisting cold intolerance in 48%, disabling hypersensitivity in 48%, and new neuroma formation proximal to or within the allograft in 25% of patients, one year post-operatively. Q-DASH showed 52% of patients with poor results. Overall, 43% of the patients had persisting pain in rest and activity. Measuring muscle strength showed grip strength of 60% and a pinch of 58% of the strength measured in the uninjured hand, which was statistically significant. Even with the excision of a neuroma in continuity and reconstruction with human acellular nerve allograft, limited functional outcome, pain, cold intolerance, and hyperesthesia may persist in the treated patients. There is also the risk of new neuroma formation proximal to or within the allograft.