https://doi.org/10.4081/ltj.2023.318

Management interventions for amputation stump neuromas: evidence based review and cost-benefit analysis

Vol. 30 No. 2 (2023)
Submitted: 30 May 2023
Accepted: 23 August 2023
Published: 12 October 2023
Amputation, neuroma, cost-benefit, laser
Abstract Views: 4073
PDF: 59
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Authors

Ernest A. Azzopardi
info@skinsurgeon.eu
Welsh Laser Service, Neath Port Talbot Hospital, Neath, Wales, United Kingdom; Skinsurgeon@ELms Clinic, Triq il Pirinej, Malta; Consultant Surgeon in Private Practice, The London Welbeck Hospital, Marylebone, London, United Kingdom; Department of Anatomy, Faculty of Medicine and Surgery, University of Malta Medical School, Malta; 5Department of Surgery, Division of Interventional Sciences, University College London, London, United Kingdom.
Philippa Stewart
Rookwood Rehabilitation Hospital Cardiff, Wales, United Kingdom.
Dean Edward Boyce
Welsh Centre for Plastic Surgery, Morriston Hospital, Abertawe, Wales, United Kingdom.
Maxwell Murison
Welsh Laser Service, Neath Port Talbot Hospital, Neath, Wales, United Kingdom.
Hazim Sadideen
Department of Surgery, Imperial College, London, United Kingdom.
Matteo Tretti Clementoni
Laserplast Srl Stp, Milan, Italy.

Amputation is a common military and civilian surgery with high morbidity. Patients without prostheses due to neuroma pain lose productivity and lifelong contributions, which is often underestimated. The surgical and non-surgical treatment of painful stump neuromas is controversial. An evidence-based assessment and cost-benefit analysis of painful stump neuroma management modalities emphasizes institutional awareness and disruptive technologies. An Oxford Centre for Evidence Based Methodology critical appraisal and structured literature review were used in the research. We found 154 records using a reproducible literature search strategy that included electronic databases and references. A full review of 27 manuscripts after exclusion criteria yielded data for analysis. Surgical, injectable, and electromagnetic spectrum methods were used. Surgical interventions had longer follow-up times than injection and radiofrequency treatments, which affected outcomes. CEBM level 4 evidence dominated primary literature, indicating low quality. No therapy was superior, but the risks varied. Injection therapies like sclerosing alcohol had limited success and side effects. Despite limited evidence, electromagnetic spectrum modalities showed potential. Including direct and indirect costs, amputation stump refitting costs millions annually. Compared to outpatient non-surgical interventions, laser therapy could save a lot of money. According to the study, surgical interventions are common but expensive and have limited functional success. Low-risk non-surgical methods like co-ablation, pulsed radiofrequency, and transcutaneous laser therapy have mixed results. The short follow-up of all non-surgical studies seems to limit them. Follow-up duration is crucial to outcome assessment. Long-term, low-risk laser-induced thermotherapy is promising for future research. This study emphasizes the need for more research and the economic benefits of disruptive technologies in treating painful stump neuromas.

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How to Cite

Azzopardi, E. A., Stewart, P., Boyce, D. E., Murison, M., Sadideen, H., & Tretti Clementoni, M. (2023). Management interventions for amputation stump neuromas: evidence based review and cost-benefit analysis. Laser Therapy, 30(2). https://doi.org/10.4081/ltj.2023.318
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