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

Poyntz, Stephanie A. MBChB Hons*; Hacking, Nicholas M. FRCA; Dalal, Milind FRCS (Plast); Fowler, Stephen MD, FRCP§

doi: 10.1097/AJP.0000000000000533
Review Articles

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.

Materials and 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 nonsurgical. Results showed that no single treatment showed superiority.

Discussion: The 4 treatments that showed most promise included targeted nerve implantation, 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.

*Foundation Year 2 Doctor

Departments of Plastic Surgery

Anaesthetics, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, PR2 9HT

§Manchester Institute of Biotechnology, Faculty of Science and Engineering

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

The work for this paper was carried out at the Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Preston, PR2 9HT.

The authors declare no conflict of interest.

Reprints: Stephanie A. Poyntz, MBChB Hons, 9 Old Wickham Lane, Haywards Heath, West Sussex, RH16 1UP, UK (e-mail:

Received June 23, 2016

Received in revised form October 5, 2016

Accepted June 23, 2017

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