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data are summarized in Table 1. No alternative options If symptoms are due exclusively to external trauma and
are mentioned for patients reporting no improvement. the patient has pain at rest, wraps or thick adipofascial
flaps are the treatment of choice to avoid external trauma
Despite published reports of highly satisfactory outcomes
and success rates close to 100% with a range of techniques, and protect the nerve. If the lesion is external to the nerve
clinical practice demonstrates that such conditions are and pain is due to scar tethering the prognosis is more
difficult to treat and at times are only partially solved. favorable and the risk of recurrence lower, whereas pain
due to intraneural injury is more difficult to treat because
There is scant published evidence regarding the diagnostic the outcome of internal neurolysis is unpredictable and
work‑up and treatment of scar neuropathy. Patients should may itself induce formation of even worse scarring.
be warned that their condition is not easy to address and Data on the timing of a recurrence varies widely, from
that surgical treatment may have to be followed by a twenty days to thirty days to months, the mechanism of
more aggressive approach if symptoms persist.
recurrence is also unclear.
Patients with pain due to nerve entrapment in scar tissue Helping patients with these conditions requires a
require careful evaluation through history, assessment multidisciplinary approach and close collaboration of the
of pain type, and accurate US scanning, to establish surgeon, pain clinician, physiotherapist, and psychologist,
the site of the scar tissue injury and whether the nerve because for reasons that are still unclear the patient is
contains internal damage. In patients for whom surgery often the very cause of the problem. The risk of persistent
will be straightforward local tissues provide a suitable or even worsening pain symptoms should be clearly stated
bed, barrier devices may be applied first to attempt to prior to surgery, as any intervention may induce symptom
treat the problem by a less invasive approach. Patients worsening in patients with complex pain syndromes.
subjected to multiple procedures due to recurrences and
those with a severely injured gliding bed require more If the pain is not alleviated following the initial procedure,
extensive neurolysis and coverage with a local or free subsequent operations are unlikely to be successful, and
vascularized flap. further attempts may involve diminishing returns. [30,76]

Table 1: List of the 21 papers describing peripheral nerve neurolysis, associated procedures, and pain outcomes
retrieved by the PubMed search, sorted by the technique used for neurolysis
Author Surgical approach Nerve Pain alleviation. Number of patients and
percentage (%) of pain reduction
Reisman and Dellon [58] Abductor digiti minimi Median Pain reduction in 11/12 patients (91)
Strickland et al. [59] Hypothenar fat pad flap Median Excellent results in alleviating recalcitrant idiopathic
CTS (95 satisfaction in 62 patients)
Rose [60] Palmaris brevis muscle flap Median Complete pain relief in all patients (13 hands) (100)
Jones [61] Pedicled or free flaps Median/ulnar Pain reduction in 7/9 patients (78)
Giunta et al. [62] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89)
Frank et al. [63] Hypothenar fat pad flap Median Pain reduction in 8/9 patients (89)
Guillemot et al. [64] Fat graft Median No pain reduction in 4 patients
Mathoulin et al. [65] Hypothenar fat pad flap Median Pain resolution in 41/45 patients (98)
De Smet and Hypothenar/ulnar fat pad flap Median Pain reduction in 9/14 patients (64)
Vandeputte [66]
Dahlin et al. [67] Pedicled ulnar, dorsal forearm flaps Median Pain reduction in 10/14 patients (71)
Free groin, scapular, lateral arm flaps
Goitz and Steichen [54] Free omental flaps Median Pain reduction in 7/11 patients (63)
Luchetti et al. [68] Fascial and fasciocutaneous island Median Four point VAS score reduction in
flaps (hypothenar fat pad, forearm radial 23/25 patients (92)
artery, forearm ulnar artery, ulnar fascial
fat, and posterior interosseous)
Craft et al. [69] Hypothenar fat pad flap Median Pain resolution in 83% of 28 patients
Fusetti et al. [70] Hypothenar fat pad flap Median Pain reduction in 18/20 patients (90)
Elliot et al. [71] Vascularized forearm fascial flap Median/ulnar Pain resolution in 8/14 patients (57)
Soltani et al. [43] Collagen: neurolysis + collagen wrap Median/ulnar Resolution/improvement in 4 patients (median)
Resolution in 3/4 patients (cubital tunnel syndrome)
Espinoza et al. [72] Microneurolysis alone versus ADCON/TN Median/ulnar Pain reduction in 80% of 54 patients
Atzei et al. [35] Neurolysis or nerve repair with Hand nerves Pain reduction quicker with Hyaloglide (R)
Hyaloglide (R) 14 patients treated with HA versus 16 treated
without gel
Varitimidis et al. [73] Autologous vein Median Pain reduction in 14/15 patients (93)
Masear [74] Vein: autologous+allograft Median Good/excellent results in 94/119 patients (79); no
and various pain relief in 9/119 patients
peripheral nerves
Kokkalis et al. [75] Vein wrap Ulnar Pain reduction in 100% of 17 patients
CTS: Carpal tunnel syndrome, VAS: Visual analogue scale

162 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015