Prevention and management of painful neuroma.

Painful neuroma is a common sequela of peripheral nerve injury which is usually resistant to pharmacologic treatment and requires surgical intervention. The widely accepted methods of neuroma management prevent regrowth of nerve fibers, thus precluding any functional repair. The present study reviews the currently used methods and experimental approaches to prevent and cure neuromas developing after peripheral nerve injury. The main recommendations are as follows. Special care should be taken to minimize scar formation when operating on peripheral nerves. The laser or scissors transection methods should be used to cut the nerve rather than electrocoagulation or cryoneurolysis. Direct nerve reconstruction, or, if a gap occurs, nerve grafting, should be performed immediately after nerve injury. Surgical resection of recurrent neuroma followed by implantation of the nerve into the muscle or capping the nerve stump with epineural graft seems to be the most effective method of prevention.