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Peripheral Interventions for Painful Stump Neuromas of the Lower Limb: A Systematic Review

Poyntz Stephanie Alexandra MBChB Hons; Dalal, Milind FRCS (Plast); Hacking, Nicholas FRCA; Fowler, Stephen MD, FRCP
The Clinical Journal of Pain: Post Acceptance: July 03, 2017
doi: 10.1097/AJP.0000000000000533
Review Article: PDF Only

Objectives:

Painful stump neuromas in lower limb amputees are a significant burden on a person’s quality of life due to interference with wearing prostheses and therefore the ability to walk. Treating painful stump neuromas is a challenge perhaps reflected by the lack of clinical guidelines both in the United Kingdom and internationally.

Methods:

A systematic review was conducted to evaluate the efficacy of all treatments tried in the management of symptomatic neuromas in the lower limb amputation stump in order to establish whether one treatment is superior.

Results:

Twenty-two studies were included in the final review which examined 14 different treatments both surgical and non-surgical. Results showed that no single treatment showed superiority.

Discussion:

The four treatments that showed most promise included targeted nerve implantation (TNI), traction neurectomy, nerve-to-nerve anastomosis and perineurial gluing. The short follow-up times and small sample sizes of the studies highlighted the need for more robust clinical studies.

Acknowledgments: Dr Fergus Jepson MBChB, Consultant in Amputee Rehabilitation, Specialist Mobility Rehabilitation Centre, Preston, UK.

No funding was received from the National Institute of Health, Wellcome Trust, Howard Hughes Medical Institute or any others.

The authors declare no conflict of interest.

Reprints: Stephanie A. Poyntz, MBChB Hons, (Until August 2016), Lancashire Teaching Hospitals Foundation Trust, Sharoe Green Lane, Preston, PR2 9HT, 9 Old Wickham Lane, Haywards Heath, West Sussex, RH16 1UP, UK (e-mail: Poyntz19@doctors.org.uk, stephen.fowler@manchester.ac.uk).

Received June 23, 2016

Accepted June 23, 2017

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