Stop Neuroma Surgical Treatment of Symptomatic Neuroma Preliminary

Stop Neuroma: Surgical Treatment of Symptomatic Neuroma Preliminary Results of a Dutch multicenter trial Mariëtta Bertleff MD, Ph. D, MSc. BA Hand Wrist Surgeon, Bergmanclinics, Naarden, The Netherlands

Neurocap® New medical device for neuroma treatment Literature highlights o Neuroma patients characteristics: ü Incidence of symptomatic end-neuromas after peripheral nerve injury is 3 -7% ü Incidence of symptomatic end-neuromas after amputation is 13 -32% ü 63 -79% of patients with neuroma pain were involved in workers compensation ü 77% require routine analgesic medication New treatment option: Neurocap® biodegradable poly-DL-lactide-caprolactone nerve capping device (Polyganics B. V. , The Netherlands) o Current outcome of treatment options: ü Non surgical outcome 30 -84% pain reduction ü Surgical outcome 15 -100% good-to-excellent ü On average patients receive 2. 3 surgeries ü More than 30 treatment options currently in use But no gold standard treatment for end-neuromas!

STOP Neuroma trial Preliminary results pre- and postop pain score Patient o Prospective non-randomised trial o 3 participating hospitals o Inclusion: o patients with symptomatic primary or secondary neuroma of upper limb o Significant pain reduction after nerve block o End-neuroma, non-reconstructable o Follow-up 12 months Neuroma site Neurocap diameter (mm) VAS (mm) pre-op VAS (mm) 6 wks postop VAS (mm) 3 months postop VAS (mm) 6 months postop VAS (mm) 12 months postop 1 F 27 SRN neuroma 2. 5 81 1 1 2 F 66 SRN neuroma 3. 0 93 9 25 30 8 3 F 42 Dorsal branch ulnar nerve and SRN 2. 5 79 6 1 3 6 4 F 25 Dorsal branch ulnar nerve 2. 0 64 1 1 72 60 5 F 22 SRN neuroma 2. 5 80 26 27 27 30 6 F 41 SRN neuroma 2. 0 78 13 12 72 62 7 M 59 Radial superficial nerve 3. 0 9 30 30 14 21 8 F 33 SRN neuroma 1. 5 80 1 9 1 1 9 F 37 SRN neuroma 1. 5 78 1 1 10 M 41 Sens branch median nerve 1. 5 91 85 72 NA NA Median 79 8 11 14 8

STOP Neuroma trial Results pre- and postop pain, Elliot and Quick. DASH VAs pain score (Median) Elliot score (median) 79 13. 0 18 VAS preoperative VAS after local block 8 11 14 VAS 6 wks postoperative VAS 3 month postoperative VAS 6 months postoperative 8. 0 8 VAS 12 months postoperative Quick DASH (median) Elliot Screening 53 Elliot 6 wks postoperative 3. 0 Elliot 3 months postoperative 3. 0 Elliot 6 months postoperative Elliot 12 months postoperative Clin Plast Surg. 2014 Jul; 41(3): 589 -613. Surgical management of painful peripheral nerves. Elliot D 1. 23 14 Quick. DASH screening 4. 0 9 14 Quick. DASH 6 wks Quick. DASH 3 months. Quick. DASH 6 months postoperative Quick. DASH 12 moniths postoperative

STOP Neuroma trial Preliminary conclusions The use of the Neurocap® is simple 60% of the patients had an significant reduction of pain All could stop pain medication 3 patients were on sick leave before surgery and could return to work after surgery. One patient had an injury 2 weeks postop to the surgical side resulting in wound breakdown (10). Before trauma he was pain free. This patient also had seroma formation around the nerve cap resulting in a second surgery after 6 months and removal of the remaining cap Patient number 7 there is doubt about preop VAS pain score