Proximal sural traction neurectomy during transtibial amputations

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Regenerative Medicine

Background:

• Symptomatic neuroma formation is a common complication following trauma-related transtibial amputations.
• The sural nerve, located subcutaneously, is vulnerable and often implicated in chronic pain and reduced prosthesis use.
• Standard sural traction neurectomy may inadvertently lead to neuroma formation in a symptomatic area.

Purpose of the Study:

• To introduce and describe a modified proximal sural traction neurectomy technique.
• To reduce the incidence of symptomatic neuroma formation at the residual limb's distal end.
• To improve patient outcomes and prosthesis utilization after transtibial amputation.

Main Methods:

• Identification of the sural nerve in the distal flap's subcutaneous tissue.
• A limited anterior approach in the proximal posterior flap to access the medial sural cutaneous nerve.
• Performing neurectomy proximally, allowing nerve retraction into a healthier tissue bed.

Main Results:

• The modified technique facilitates nerve retraction into a more proximal tissue bed compared to standard neurectomy.
• This proximal repositioning aims to prevent neuroma formation in areas prone to symptomatic irritation from prosthesis wear.
• The described approach offers a potentially more effective solution for managing sural nerve-related neuroma complications.

Conclusions:

• The modified proximal sural traction neurectomy is a viable surgical option for preventing symptomatic neuroma formation.
• This technique addresses the limitations of standard neurectomy by repositioning the nerve more proximally.
• Improved management of sural nerve neuromas can lead to better functional outcomes and patient satisfaction post-amputation.