Incidence of painful neuroma after end-to-end nerve suture wrapped into a collagen conduit. A prospective study of 185 cases

Three to 5% of the nerves directly and correctly sutured evolve towards significant neuropathy pain. The psychological, social and economic impact of such a consequence is very important. The purpose of this retrospective study was to evaluate the incidence of the occurrence of a trigger zone or a neuroma, at 6 months of maximum follow-up after direct nervous suture bushed in a type 1 collagen tube. Every patient taken care for a traumatic nervous injury from November 2008 to March 2012 was included in the study. The exclusion criteria were any replantation, nervous tissue defect and any distal nervous stump which could not technically be wrapped around. The only conduct used was made of collagen type 1 (Revolnerv (R), Orthomed (TM)). All patients were examined after one, three and six months for a clinical evaluation made by the same surgeon. The apparition of a trigger zone or a real neuroma was clinically assessed. One hundred and seventy-four patients for a total of 197 sutured nerves were included in the study. At the 6 months follow-up, 163 patients were evaluated for a total of 185 nerves. No patient suffered from a neuroma at this time. As the treatment of neuroma is very difficult, considering the cost and the results, wrapping direct end-to-end sutures by a collagen type 1 tube seems helping to prevent the appearance of a neuroma. (C) 2013 Elsevier Masson SAS. All rights reserved.