Primary Targeted Muscle Reinnervation to Prevent Neuroma and Phantom Limb Pain in Lower Extremity Amputee
J Byers Bowen, MD, MS, Daniel I. Ruter, B.S., Ian L. Valerio, MD, MS, MBA, FACS.
The Ohio State University, Columbus, OH, USA.
Previous studies prove targeted muscle reinnervation (TMR) successfully treats and can resolve peripheral neuroma (PN) and phantom limb pain (PLP) in amputee patients. This study examines the incidence of PN, PLP, and associated outcomes when TMR is performed at the time of initial lower extremity amputation.
A retrospective review of primary lower extremity TMR patients was completed. At operation, major amputated motor-sensory and sensory peripheral nerves are identified. Proximal motor nerves entering specific muscle units are located. Target motor nerves are divided near their associated muscle and prior amputated nerves are coapted. The full technique and clinical examples will be presented. Subjects were followed at one, three, six, and twelve-month intervals to evaluate symptoms of PN, PLP, phantom limb sensation, patient satisfaction, and functionality.
Fifteen patients underwent primary TMR. Ages 9-67 years with average follow up 11.5 months (1-28 months). One patient reported PN at one month, resolving by three months. At one month, 73% of patients reported PLP, resolving in all patients by three months. At three months, a majority of patients demonstrated targeted specific muscle reanimation.
Our study suggests TMR can decrease the incidence of PN and PLP when performed at time of amputation. Our patients demonstrate early muscle fasciculation suggesting better muscle motor end plate function and less disuse/atrophy due to earlier nerve - muscle interface. We note trends towards quicker disuse of narcotics. This study further strengthens the use of TMR towards the prevention of PN and PLP.
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