Neuroma

A neuroma is a benign nodule formation after transection of a peripheral nerve ( neurectomy ) may occur at the site of the defect.

Formation

Nerves, when they are severed during injury ( neurotmesis ) or surgery ( neurotomy or neurectomy ) or isolated the axon by pressure or train is damaged ( axonotmesis ), regenerate. The axon grows out toward the periphery in order to reach the target organ, to which the nerve originally belonged again. The connective-tissue structures surrounding the nerve, the perineurium, are to be used as a guide rail.

However, results from each wound scar tissue, whose main component is collagen fibers. Try an axon to penetrate this tissue to reach the severed end of the nerve again, it happens that the sprouting of nerve fibers aufknäuelt in the resulting scar tissue and forms a neuroma. Where false information can cause nerve, which usually manifest themselves as pain. In some old surgical scars can feel for these thickenings. Often a clear and circumscribed pain on pressure is specified at exactly this point.

Even with a faulty conducted blood donation can form a neuroma after an injury to the skin nerve. A blood transfusion service, who had not cleared the blood donors for this rare risk, was sentenced by the federal court for damages.

Therapy

The best therapy is not to favor a priori the existence of these neuromas. For the operator, this means to be as soft tissue gently as possible, the buzzword is " atraumatic ". Encapsulation with local anesthetics can often relieve the symptoms; Friction massages can break up the scar tissue. Surgical treatment often disappointingly. While it is possible without much difficulty to go to a neuroma and cut out, but often it grows quickly after, and in some cases later prepare more problems than before the operation. Newer methods of plastic surgery, therefore, leave the nerve stump after removing the Neuromes not loose in the tissue, but it is the stump sewn into the target organ to prevent the re neuroma. Motor nerves are, for example, anchored in the deep muscles. Cutaneous nerves can be obliterated by Neuromentfernung or be anchored in the deep fat layer sewn into a bag then deepithelialized skin.