Background: Patients with chronic wounds due to healing problems also often present with chronic pain at the site. Proper wound care and/or an appropriate reconstruction usually address both wound and its associated pain. However, wounds occasionally remain painful despite successful reconstruction, particularly when complicated by an underlying condition (such as sickle cell disease). These patients frequently develop a disabling chronic pain condition despite the application of current treatment modalities, including narcotic and non-narcotic analgesia, physical therapy, nerve blocks, and psychotherapy. In this study, a novel approach is evaluated for the management of this difficult clinical situation, by addressing the sensory nerve supply to the affected wound region. Methods: Eight patients (five female and three male) with intractable chronic pain despite wound reconstruction underwent surgery and were followed for a mean of 27 months (range of 8 to 40 months). The involved sensory nerve was identified preoperatively by physical exam and confirmed by nerve block, and was then surgically excised and implanted into adjacent muscle. Patient's pain reduction, ambulation status and quality of life improvement were evaluated. Wilcoxon rank test and Fisher's exact test were used for data analysis. Results: The involved nerves in this patient group included the ilioinguinal, lateral femoral cutaneous, sural, saphenous, superficial peroneal, deep peroneal, and genital branch of the genitofemoral nerve. All eight patients reported significant pain reduction (p<0.0001), improved ambulation (p<0.0001), and improved quality of life (p<0.0001), as evaluated at the time of the last follow up visit (mean of 27 months). Conclusions: Chronic wounds are not only a metabolic and infectious burden to the patient, but can be a source of disabling pain despite adequate wound reconstruction. This study suggests that an additional treatment modality in management of chronic wounds can be considered for patients with disabling pain. A treatment algorithm is presented along with the technique. As an adjunct to other interventions, this novel application of peripheral nerve surgery can critically improve symptoms in selected patients with intractable chronic wound pain.
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