Stromal Vascular Fraction-Enriched Fat Grafting for the Management of Symptomatic Neuromas

Begin with an anesthetized patient experiencing symptomatic pain from a suspected neuroma in the superficial branch of the radial nerve.

Neuromas are painful nerve growths that develop after nerve injury.

Make a skin incision in the distal forearm.

Dissect the subcutaneous tissue to expose the nerve and trace its course distally.

If no neuroma is detected, perform neurolysis by removing scar tissue around the nerve.

Make small stab incisions around the skin incision and insert blunt cannulas, directing the tips toward the nerve.

Secure the cannulas with an adhesive dressing.

Suture the main incision.

Inject Stromal vascular fraction or SVF-enriched fat graft around the nerve through the cannulas.

The fat graft forms a mechanical barrier, preventing abnormal nerve sprouting.

SVF, a mix of regenerative cells isolated from adipose tissue, minimizes fat resorption and enhances graft longevity.

Remove the cannulas, close the stab incisions, and bandage the surgical site.

To approach the neuroma, make a skin incision over the diagnosed site, which in this case is 3 centimeters distal to the wrist. To identify the involved nerve proximal to the neuroma, wear surgical binocular loops, and dissect the subcutaneous tissue. Once the full extent of the neuroma is exposed, use a straight trans neural scissor cut to excise the neuroma.

Proper identification of the neuroma is critical. Dissect until the nerve is visible. And to identify the neuroma, simply follow the nerve distally until the neuroma formation is found.

Next, perform neurolysis on the remaining nerve stump until the end of the nerve stump is located in the middle of the principal incision. In this case, as no neuroma was present, neurolysis only was performed.

Now, through epidermal and dermal cutis around the principle approach, make two to four small 1 millimeter puncture incisions using a scalpel. Then through the incisions, place four blunt cannulas perineural to the nerve stump with the cannula tips directed at the stump. To ensure that the cannulas remain in situ, secure the cannulas with adhesive dressing.

Special care should be taken to direct the cannulas precisely at the nerve stump and secure them in place thus guaranteeing that the nerve stump can be totally covered by the stromal vascular fraction enriched fat grafts.

Next, suture the main incision tightly. So the graft solution that is to be delivered into the tissue via the cannulas will remain in situ. Now, aspirate the 5 milliliters of processed SVF into one barrel of a 10 milliliters communicating syringe.

Then transfer 2 milliliters of the sedimented lipid from the set aside Toomey syringe into the opposing barrel of the communicating syringe. Now, using the plungers, mix the SVF and lipids until the sedimented lipid is evenly distributed in the SVF.

Next, divide the 7 milliliters of SVF enriched fat graft equally into two to four 10 milliliters syringes. Then, carefully secure the two to four syringes to the cannulas, and distribute the graft mixture around the nerve stump via the blunt cannulas. Once the graft has been delivered, remove the cannulas carefully. Then tape the small puncture incisions with steri-strips. Finally, the arm and wrist are bandaged for 10 days.