Name of the Procedure:

Excision of neuroma; cutaneous nerve, surgically identifiable

Summary

An excision of a neuroma involves the surgical removal of a benign growth on a cutaneous nerve. It is performed to relieve pain or discomfort caused by the neuroma compressing the nerve.

Purpose

This procedure addresses the presence of a neuroma, which can cause significant pain, tingling, or numbness due to nerve compression. The goal is to excise the neuroma to alleviate symptoms and improve the patient's quality of life.

Indications

• Persistent pain, tingling, or numbness in the area served by the cutaneous nerve
• Failure of conservative treatments (e.g., medication, physical therapy)
• Confirmed diagnosis of neuroma through clinical evaluation or imaging

Preparation

• Fasting for at least 8 hours before the procedure if anesthesia will be used
• Adjustment or discontinuation of certain medications as per doctor's advice
• Preoperative diagnostic tests such as MRI or ultrasound to locate the neuroma accurately

Procedure Description

1. The patient is positioned and draped for sterile access.
2. Local or general anesthesia is administered.
3. An incision is made over the site of the neuroma.
4. The surgeon identifies and isolates the nerve containing the neuroma.
5. The neuroma is carefully excised from the nerve.
6. The incision is closed with sutures.
7. A sterile dressing is applied.

Duration

Typically, the procedure takes between 30 minutes to 1 hour.

Setting

This procedure is usually performed in an outpatient surgical center or a hospital's day surgery unit.

Personnel

• Surgeon specialized in peripheral nerve surgery or hand surgery
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)
• Surgical nurses and assistants

Risks and Complications

• Infection at the surgical site
• Bleeding
• Scarring
• Potential for nerve damage, leading to altered sensation or continued pain
• Recurrence of the neuroma

Benefits

• Significant reduction or elimination of pain and discomfort
• Improved function and quality of life
• Relief from neurological symptoms

Recovery

• Post-procedure care includes keeping the incision site clean and dry.
• Pain management with prescribed medications.
• Light activities initially, gradually returning to normal activities within a few weeks.
• Follow-up appointments for suture removal and to monitor healing.

Alternatives

• Conservative treatments such as medication, physical therapy, or orthotic devices
• Corticosteroid injections
• Radiofrequency ablation or cryotherapy
• Pros of alternatives: Non-invasive with minimal recovery time
• Cons of alternatives: May provide only temporary relief

Patient Experience

During the procedure, patients under general anesthesia will be asleep and feel no pain. If local anesthesia is used, there may be some discomfort at the injection site but no pain during neuroma excision. Post-procedure, mild to moderate pain is common but manageable with medications. Most patients experience relief from symptoms within a few days to weeks.