The painful stump neuroma and its treatment.

Successful clinical management of symptomatic neuromas continues to present a challenge to the responsible surgeon. It is unexplained why some patients with neuromas are completely asymptomatic while others exhibit debilitating symptoms. Prevention of neuromas is paramount with precise attention to severed nerves following amputations and other surgical procedures. Once established, treatment of neuromas consists of careful patient counseling, local massage, and desensitization procedures. Sympathetic blockade with guanethidine may be beneficial in some patients. When necessary, surgical excision of the neuroma along with a combination of funiculectomy, epineurial sleeve suture ligation, and silicone capping offers the best chance for eradication. In intractable or recurrent cases and following careful patient selection, neuroma excision followed by nerve grafting combined with sympathetic blockade using guanethidine can be successful in a significant number of cases.