F OLLOWING major extremity amputation a large proportion of patients will retain quite specific impressions of their missing limb, persisting for months, years, or as long as they live. Weir Mitchell s studied a series of 90 major amputations during and after the American Civil War, and in 86 of these cases found characteristic" phantom" limb symptoms. More recently Leriche, 4 Livingston, s, 6, 7 Bailey and Moersch 1 and others 9'1~ have emphasized the frequency and uniformity of this phenomenon following amputation.

Such phantom limb symptoms become clinically important when associated with protracted or severe pain, However, of all patients with welldefined phantom limb sensation, comparatively few (probably less than 10 per cent) will have severe persisting pain referred to the phantom limb. In a majority of these cases the first attempt to obtain relief has been through resection of major nerve neuromas. Neuromas subjected to mechanical insult from muscle traction, lack of soft-tissue protection, pressure of prosthesis, etc., may become a source of real pain. In such cases removal of the neuroma and protection of the area from mechanical trauma will relieve the symptoms. This pain is always directly dependent upon the traumatic factors and is readily differentiated from true phantom limb pain. In true phantom limb pain clinical results of neuroma resection have been generally disappointing, l, ss, 9.10, 12 and the role of the major peripheral nerve neuromas, both in relation to the phantom limb impression itself and in phantom limb pain, has remained confused.