Prevention of painful neuromas by epineural ligatures, flaps and grafts.

Neuroma formation at the proximal end of a divided nerve is a common problem in peripheral nerve surgery. Forty-eight nerve endings in 23 patients with traumatic or post-elective surgery amputation stumps were capped with either an epineural ligature, epineural flaps or an epineural graft. Each technique was used on 16 nerve endings. After at least 6 months follow-up, pain at the nerve endings was assessed by tapping the treatment sites and asking the patients to score their pain on a visual analogue scale (VAS) from 0 to 10. The mean VAS scores were 5.18 for epineural ligatures, 4.25 for epineural flaps and 2.06 for epineural grafts. Epineural grafts were significantly more effective in preventing neuroma pain (ANOVA: F = 11.4, P < 0.05).