Painful neuroma requiring surgical excision after lower limb amputation caused by landmine explosions

Abstract

This article reports an analysis of 75 consecutive lower limb amputees who developed painful neuroma requiring surgical excision after lower limb amputation following landmine explosions. This retrospective study analyses the results of 75 patients who were treated for painful neuroma after lower limb amputation following landmine explosions between the years 2000 and 2006. The average time period from use of prosthesis to start of symptoms suggesting neuroma was 9.6 months. The average time period from start of pain symptoms to neuroma surgery was 7.8 months. All clinically proven neuromas were surgically resected. In the mean follow-up of 2.8 years, all patients were satisfied with the end results and all were free of any pain symptoms. Painful stump with clinical diagnostic findings of neuroma described above may be regarded as neuroma without requiring any further imaging modalities and is an indication for surgery if conservative measures fail.

Effects of tail docking and docking length on neuroanatomical changes in healed tail tips of pigs

“…Neuroma formation has been shown after nerve transection in other animal species and after removal of tails (Gross and Carr, 1990;French and Morgan, 1992), as well as other types of tissue (Breward and Gentle, 1985), including humans (Sehirlioglu et al, 2009) and rodents as part of animal-model studies using experimental nerve transection (Dorsi et al, 2008); however, previous reports have not focused on the effects of the proportion of tissue removed on neuroma formation.…”

Painful Terminal Neuroma Prevention by Capping PRGD/PDLLA Conduit in Rat Sciatic Nerves

“…For the initial damage in peripheral nerve, residual axons undergo Wallerian degeneration, apoptosis, axons extension, and remyelination to achieve recovery 5. However, this limits regenerative ability that is not sufficient to overcome the long‐distance gap (>50 mm) or fail without the guidance of distal stump, which are typical neuropathic symptoms in serve trauma and amputation 6. In this case, a sprout can be observed at the proximal stump and axon extends spontaneously,7 but they are randomly oriented and chaotic milieu triggers a subsequent disorganization of remyelinations.…”

Regenerative Peripheral Nerve Interfaces for the Treatment of Postamputation Neuroma Pain: A Pilot Study

“…2 Painful neuromas develop in 12.5% to 50% of cases, 3,4 preventing or limiting prosthetic restoration and diminishing quality of life. Up to 30% of patients abandon their prostheses for reasons including neuroma pain.…”

“…9 Nonsurgical treatment includes desensitization, chemical or anesthetic injections, transcutaneous electrical nerve stimulation, topical lidocaine, and adjuvant pain medications such as antidepressants and anticonvulsants. 7 Recalcitrant cases are subject to various surgical treatments such as simple neuroma excision, 4 nerve capping, 10–12 and nerve relocation into bone, 13 muscle, 13–15 or vein. 7 Fibrin patch application with placement of a local pain catheter has also been described.…”