The prevention and treatment of amputation neuromata by silicone capping

A technique of silicone capping of amputated sciatic or tibial nerves was evaluated in a single litter of ten New Zealand white rabbits (eight experimental, two control). All nerves and caps were evaluated 12 and 4 weeks after operation. Neuroma formation was prevented when a lengh:diameter ratio of 5:1 (minimum) to 10:1 (maximum) of the cap was observed and a smooth, filmy, nonreactive capsule around all nerve ends and caps was noted. Eighteen patients with 38 traumatic neuromata in the upper extremity were treated by silicone capping and were evaluated an average of 41 months after operation. Of these 18 patients, 17 underwent revision surgery for the specific purpose of relieving disabling neuroma pain. Two patients developed a causalgic state. One patient had recurrence of symptoms in one of four nerves capped and was relieved by reoperation and recapping. The remaining 15 patients were relieved of their preoperative complaints.