Neuroma
| Classification according to ICD-10 | |
|---|---|
| T87.3 | Neuroma of the amputation stump |
| G59.8 * | Other mononeuropathies in diseases classified elsewhere |
| ICD-10 online (WHO version 2019) | |
A neuroma is a benign nodule that can develop at the site of the defect after a peripheral nerve has been severed ( neurectomy ).
Emergence
Peripheral nerves can regenerate if they are severed during injuries ( neurotmesis ) or operations ( neurotomy or neurectomy ) or if the axon is isolated by pressure or tension ( axonotmesis ). The axon grows out towards the periphery in order to reach the successful organ to which the nerve originally belonged again. The connective tissue structures that surround the nerve, the perineurium , are used like a guide rail.
However, every wound healing process creates scar tissue, the main component of which is collagen fibers . If an axon tries to penetrate this tissue in order to reach the severed end of the nerve again, it can happen that the sprouting nerve fiber bundles up in the scar tissue and forms a neuroma. False nerve information can arise here, which is usually expressed as pain. These thickenings can be felt in some old surgical scars. Often a clear and circumscribed pressure pain is indicated precisely at this point.
Even if the blood donation was carried out incorrectly, a neuroma can form after an injury to the cutaneous nerve. A blood donation service that did not inform the blood donor about this rare risk was sentenced to compensation by the Federal Court of Justice.
therapy
The best therapy is not to favor the development of such neuromas from the outset. For the surgeon, this means proceeding as gently as possible on the soft tissues, the catchphrase is “atraumatic”. Injecting local anesthetics around can often relieve the discomfort; Friction massages can loosen up the scar tissue. The surgical treatment is often disappointing. It is possible to locate and excise a neuroma without much difficulty, but it often grows back quickly and in some cases can cause more problems later than before the operation. More recent methods from plastic surgery therefore do not leave the nerve stump loose in the tissue after the neuroma has been removed, but rather the stump is sewn into the successor organ to prevent the neuroma from forming again. Motor nerves are z. B. anchored in the deep muscles. Skin nerves can be obliterated after the removal of the neuroma or sewn into a deepithelialized skin pocket and then anchored in the deep fat layer.
Individual evidence
- ^ BGH, judgment of March 14, 2006 , Az. VI ZR 279/04, full text.
