Clinical Context
A 52-year-old male with a below-elbow amputation of the dominant right arm presents to the outpatient surgical clinic with persistent painful neuroma formation, scar contracture, and poorly fitting soft-tissue envelope at the distal stump interfering with prosthetic use. The patient reports localized deep stump pain exacerbated by prosthesis wear and limited range of motion of adjacent joints due to scar contracture. Physical exam demonstrates tethered scar, prominence of a painful neuroma, and inadequate soft-tissue padding over the distal residual limb. Prior attempts at conservative management (stump desensitization, prosthetic modification, and local steroid injection) were unsuccessful.
The clinical workflow includes preoperative evaluation and informed consent, review of prior operative reports, possible ultrasound or MRI to localize neuromas, perioperative antibiotics as indicated, and scheduling in an ambulatory surgical center or hospital outpatient department. Under regional or general anesthesia, the surgeon performs revision amputation and soft-tissue remodeling of the residual limb: excision of neuroma, release of contracture, scar revision, recontouring of skin and muscle to improve padding and prosthetic fit, and layered closure. Postoperative care includes wound checks, dressing changes, pain control, and early prosthetic rehabilitation and occupational therapy for stump shaping and desensitization.