The Use of Fibrin Glue in the Treatment of Painful Neuromata

Abstract

As a result of traumatic or surgical division of nerves, the occurrence of painful neuromata remains a challenge to therapy. The use of fibrin sealant (Tissucol) we present here is another possible therapeutic approach, in addition to the already numerous available methods to handle such problems.

The technique consists of:

• 1. Resecting the neuromata

• 2. Fixing the nerve stump in nonscarry tissue with Tissucol

The results on 27 neuromata (17 patients) were studied using objective and subjective criteria, with 78% of recoveries and 22% of failures.

Unfortunately the method is no panacea, but appears as a worthwhile alternative which compares favorably with other proposed treatments. It has three advantages: It is atraumatic, simple and quick. There are no contraindications.

The occurrence of a symptomatic neuroma after traumatic or surgical section of a sensitive peripheral nerve remains a problem not yet really well solved, as can be seen from the numerous different publications treating this subject. Indeed, the functional limitation resulting from the traumatic pathology of the hand — mutilating in itself — is further intensified by the problems linked to an amputation neuroma.

The large number of techniques described in the literature attests to the problems met in trying to elaborate a single and preferential way to solve them.

These various methods include prophylactic means and treatments such as tapping (or patting) [16]; infiltrating such substances as formol [1], phenol [2], alcohol [3], cephalorachidian liquid [4], and corticoids [5]; electrocoagulation, ligature or resection and burying into various tissues such as muscle [7], vessel [8], bone [9–11], another nerve [12–15] or also into inorganic materials like tantalum [16], gold [17] or silicon [18–20].

Since 1981, we have used a technique based on creating a “muff” or sheath to protect the nervous end with fibrin glue, which at the same time helps to set it in the best possible site and position, and this atraumatically.