Proximal sural traction neurectomy during transtibial amputations

Scott M. Tintle, Michael A. Donohue, Scott Shawen, Jonathan A. Forsberg, Benjamin K. Potter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Symptomatic neuroma formation after trauma-related transtibial amputations remains a clinical problem. The sural nerve is frequently overlooked in its vulnerable subcutaneous location in the posterior myofasciocutaneous flap and commonly leads to chronic pain and decreased prosthesis use. The standard sural traction neurectomy may actually predispose the sural neuroma to form in a region that becomes symptomatic with prosthesis wear. The proposed modified proximal sural traction neurectomy using a standard or extended posterior flap begins with identification of the sural nerve in the subcutaneous tissue of the distal flap in identical fashion to a standard sural neurectomy. In the proximal posterior flap, a limited anterior approach is then performed and gentle traction on the distal end of the sural nerve aids in the identification of the most proximally accessible portion of the medial sural cutaneous nerve. After locating the medial sural cutaneous nerve proximally, a neurectomy at this location is performed, allowing the retraction of the nerve into a healthy tissue bed substantially more proximal than with a standard sural neurectomy. This technique ensures that the resulting neuroma does not form directly at the distal end of the residual limb where it is, in our experience, more likely to become symptomatic.

Original languageEnglish
Pages (from-to)123-126
Number of pages4
JournalJournal of Orthopaedic Trauma
Issue number2
StatePublished - Feb 2012
Externally publishedYes


  • neuroma
  • sural nerve
  • traction neurectomy
  • transtibial amputation


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