Striving for Consensus: Neuroma Prevention and Preferred Approaches in Surgical Digit Amputations-A Survey of Hand Surgeons.

Background: Although surgical digit amputations are common procedures in hand surgery, substantial differences in technical approaches have been reported, with the development of symptomatic neuromas posing a major challenge. Given the absence of a universally accepted technique, especially concerning painful neuroma prevention, this survey study's rationale was to explore the preferred surgical approach for traumatic noninfected digital amputation injuries (excluding the thumb) at the interphalangeal (IP) joint levels. Methods: A 10-point online questionnaire was sent to ÖGH, DGH and SGH members. To provide a comprehensive overview of the preferred approach, descriptive statistics were performed, while examining differences based on years of surgical experience (≤20 years versus >20) and society affiliation (ÖGH vs. DGH vs. SGH) via inferential Pearson-chi square and Fisher's exact tests were employed. Results: Of the 1670 experts contacted, 213 (12.8%) took part in the survey. Across different societies and years of surgical experience, there is a consensus on most aspects, including smoothing bony edges after transosseous resection (99.8%), removal of articular cartilage after disarticulation (78.9%), shortening flexor tendons (81.2%), and avoiding additional extensor tendon shortening (92.3%). No consensus was found on the technique of surgical bone transection, the reduction of the phalangeal head during disarticulation and the treatment of digital nerves including neuroma prevention. Conclusions: Although there is a broad consensus on most aspects of surgical digit amputation, the treatment of digital nerves and neuroma prevention remains an area with a lack of consensus. Future studies should focus on these aspects to uncover further benefits.