Other Surgical Techniques for Treatment of Neuroma: Relocation Nerve Grafting, Centro-Central Neurorrhaphy, Nerve Cap, End-to-Side Neurorrhaphy

In end-to-side (ETS) neurorrhaphy an injured distal or proximal nerve stump is coaptated to the side of an existing healthy nearby nerve through a microsurgical epineural suture with or without a small epineural window. Among different indications for ETS neurorrhaphy, the technique of coapting a proximal nerve stump to a nearby functioning nerve can be used to prevent undirected axonal sprouting leading to development of painful neuromas. A valuable aspect in ETS neurorrhaphy is the guided reinnervation of a new end organ. However, the regeneration speed might be slower compared to end-to-end coaptation. In total, end-to-side neurorrhaphy is a potential method for neuroma treatment that can be performed in both upper and lower extremity. The techniques of relocation nerve grafting, centro-central neurorrhaphy, and nerve caps are additional techniques for management of end neuromas.