Systematic review on the centrocentral anastomosis technique for the surgical treatment of traumatic neuromas

Aim: Centrocentral anastomosis (CCA) can be applied in the treatment of painful neuromas, by connecting nerve ends or fascicles after neuroma resection, with or without an interposed nerve graft. While this technique was developed directly after the introduction of microsurgical techniques, it is currently not frequently applied in neuroma treatment. Methods: In this article, the literature on CCA was systematically reviewed, both for clinical and experimental studies. Specific attention was paid to the different surgical techniques, potential applications, and pathophysiologic mechanisms that might explain how CCA can prevent neuroma formation. Results: A total of 15 articles were found on this subject, 11 clinical and 4 experimental studies. In clinical studies, CCA was mostly applied for neuroma treatment following amputation of fingers and lower limbs. In experimental studies, different combinations of nerve connections and grafts were investigated in the rat sciatic nerve model. Pain reduction in the clinical studies overall was good to excellent, but only in two studies control groups were used. Results from experimental studies showed that the use of an interposed graft was beneficial by entrapment of axons inside the graft. Conclusion: Although CCA has shown promising results for neuroma treatment, there are only a few case series to date, one cohort and one randomized study, and in the latter two, no graft was used. More research is needed to investigate the outcome of CCA, especially for the option of an interposed nerve graft. This investigation should involve comparisons with alternative techniques, utilization of standardized outcome measures, and, preferably, inclusion of longer follow-up periods.