Painful scar neuropathy: principles of diagnosis and treatment

Research output: Contribution to journalArticlepeer-review

Abstract

Nerve‑tissue interactions are critical. Peripheral nerve injuries may involve intraneural andextraneural scar formation and affect nerve gliding planes, sometimes leading to complex clinicalpresentations. All of these pathological entities involve pain as the main clinical symptom andcan be subsumed under the term “painful scar neuropathy”. The authors review the literature ontreatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis‑associatedprocedures and propose a simple classification and a therapeutic approach to scar neuropathy. Thesearch retrieved twenty-one papers, twenty of which reported pain reduction or resolution withvarious techniques. There is no consensus on the best therapeutic approach to neuropathic paindue to scar tethering. Most authors report good or excellent results with different techniques, fromnerve wrapping with anti‑adhesion devices to nerve coverage or wrapping with vascularized tissue.The authors’ classification of and therapeutic approach to peripheral nerve scar lesions aims atpromoting a logical approach based on the analysis of lesion type (perineural, or endoneural andperineural), pain type (due to traction or external trauma, pain at rest), and number of previousoperations. Patients need to be informed that multiple procedures may be required, that outcomesmay be partial, and that surgery can potentially worsen preoperative conditions. The review foundno evidence for the best therapeutic approach to scar neuropathy, but there is consensus on amultidisciplinary approach.
Original languageEnglish
Pages (from-to)156-164
Number of pages9
JournalPLASTIC AND AESTHETIC RESEARCH
Volume2
Publication statusPublished - 2015

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