Mateusz Gładysz FESSH prep

FESSH prep Peripheral nerve injury Randomised evidence for targeted muscle reinnervation against excision and burying, comparative meta analysis of neuroma operations, residual function in a neuroma in continuity, traction neurectomy against bipolar cautery at digital amputation, evidence base for prophylactic regenerative peripheral nerve interfaces

Symptomatic neuroma: prevention and surgical treatment

Last reviewed v1.0

FESSH-091Peripheral nerve injury●●● advanced

Regarding the prevention and surgical treatment of symptomatic neuroma:

  1. 1.In a randomised trial in major limb amputees with chronic pain, results for phantom limb pain favoured targeted muscle reinnervation over neuroma excision with burying in muscle.

  2. 2.In a comparative meta-analysis of 54 studies of surgery for painful extremity neuromas, one technique gave significantly better pain relief overall than the others.

  3. 3.When considering excision of a neuroma-in-continuity, the potential loss of residual nerve function must be weighed against the expected benefit.

  4. 4.In a single-centre review of 815 digital amputations, traction neurectomy of the digital nerves was associated with fewer symptomatic neuromas than bipolar cautery.

  5. 5.As of a 2026 systematic review, the evidence that prophylactic regenerative peripheral nerve interfaces at amputation reduce symptomatic neuroma came from randomised controlled trials.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-091
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a randomised trial in major limb amputees with chronic pain, results for phantom limb pain favoured targeted muscle reinnervation over neuroma excision with burying in muscle.

    True

    Dumanian and colleagues randomised 28 amputees to targeted muscle reinnervation (TMR) or neuroma excision and burying into muscle. At 1 year the intention-to-treat difference in phantom limb pain favoured TMR but narrowly missed significance (adjusted P = 0.06), whereas the longitudinal analysis showed a significantly greater reduction with TMR, and residual limb pain trended in its favour. The authors conclude that TMR improved phantom limb pain compared with conventional neurectomy.

    • Dumanian GA, Potter BK, Mioton LM, Ko JH, Cheesborough JE, Souza JM, et al.. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. Ann Surg. 2019;270(2):238-246. PMID 30371518

  2. 2. In a comparative meta-analysis of 54 studies of surgery for painful extremity neuromas, one technique gave significantly better pain relief overall than the others.

    False

    Poppler and colleagues pooled 54 studies of excision alone, excision with transposition, excision with capping, excision with repair, and neurolysis with coverage. Surgery gave a meaningful reduction in pain in 77% of patients overall, with no significant difference between techniques; only in studies of long-standing pain or repeated previous operations did transposition or neurolysis with coverage perform better. Few of the included studies controlled for confounding.

    • Poppler LH, Parikh RP, Bichanich MJ, Rebehn K, Bettlach CR, Mackinnon SE, et al.. Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Pain. 2018;159(2):214-223. PMID 29189515

  3. 3. When considering excision of a neuroma-in-continuity, the potential loss of residual nerve function must be weighed against the expected benefit.

    True

    A neuroma-in-continuity may contain functioning fascicles alongside injured fascicles. Excision can sacrifice useful function, so the choice of treatment depends on the residual sensory and motor function and the lesion’s anatomy.

    • Mackinnon SE, Glickman LT, Dagum A. A technique for the treatment of neuroma in-continuity. Journal of reconstructive microsurgery. 1992;8(5):379-83. PMID 1404067
    • Vernadakis AJ, Humphreys DB, Mackinnon SE. Distal anterior interosseous nerve in the recurrent motor branch graft for reconstruction of a median nerve neuroma-in-continuity. Journal of reconstructive microsurgery. 2004;20(1):7-11. PMID 14973769
    • Walsh AR, Beutel BG, Tordjman D, da Costa AC, Melamed E. Neuroma-in-continuity: a review of pathophysiology and approach to the affected patient. Hand surgery & rehabilitation. 2023;42(2):103-108. PMID 36758942

  4. 4. In a single-centre review of 815 digital amputations, traction neurectomy of the digital nerves was associated with fewer symptomatic neuromas than bipolar cautery.

    False

    In this series, the overall incidence of symptomatic neuroma was 6.26%. Neuromas followed 9.96% of traction neurectomies against 5.04% of bipolar cautery cases (unadjusted odds ratio 2.08), so traction neurectomy was associated with more, not fewer, neuromas. The comparison is retrospective and unadjusted.

    • Nagra R, Parthiban S, Austin T, Mano J, McGhee C, Ahmed Z, et al.. The Incidence and aetiology of symptomatic neuroma development following digital amputation; a single centre observational study. J Plast Reconstr Aesthet Surg. 2026. PMID 42810890

  5. 5. As of a 2026 systematic review, the evidence that prophylactic regenerative peripheral nerve interfaces at amputation reduce symptomatic neuroma came from randomised controlled trials.

    False

    The 2026 systematic review of prophylactic regenerative peripheral nerve interface (RPNI) surgery at amputation included five comparative cohort studies (238 patients). RPNI was associated with markedly fewer symptomatic neuromas (0 of 97 against 20 of 99) and less phantom limb pain, but the authors grade the certainty as low to very low, based on observational data, and call for prospective, adequately powered comparative studies.

    • Gabriyanchik M, Pirogov K, Startseva O, Meskhi K, Reshetov I. Prophylactic Regenerative Peripheral Nerve Interfaces for Prevention of Postamputation Pain: A Systematic Review and Meta-Analysis of Comparative Clinical Studies. J Clin Med. 2026;15(15):5959. PMID 42590062