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Lower Extremity Amputee Outcomes Following Immediate Targeted Muscle Reinnervation
Jason D. Hehr, MD; Andrew O'Brien, MD, MPH; Julie West, PA-C; Ian Valerio, MD
The Ohio State University Wexner Medical Center
2019-02-15
Presenter: Jason D. Hehr, MD
Affidavit:
The resident has equally worked in conjunction with the additional authors in the completion of this work.
Director Name: Greg Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Objectives: Painful neuromas, residual limb pain (RLP), and phantom limb pain (PLP) commonly occur in major extremity amputees. The technique and timing of targeted muscle reinnervation (TMR) has evolved over the last several years, now representing a meaningful intervention at time of amputation.
Methods: A retrospective review of patients undergoing immediate TMR at time of lower extremity amputation was completed. Pain severity scores were calculated using the validated PROMIS survey (Patient Reported Outcome Measurement Information System). Our immediate TMR cohort was compared to a control cohort consisting of lower extremity amputees who have not previously undergone TMR.
Results:
In total, 36 patients undergoing immediate lower extremity TMR at time of amputation were included in this study. There was no statistical difference among level of amputation while indications for amputation varied among oncologic, traumatic and other reasons. When considering phantom limb outcomes based on PROMIS pain data in our general amputees as compared to the immediate TMR cohort; intensity scores decreased from 45.9 to 38, pain behavior decreased from 54.2 to 46, and pain interference decreased from 54.1 to 44.3, all representing statistically significant decreases (p=0.000). When considering residual limb pain outcomes between our control and immediate TMR cohorts respectively; intensity decreased from 45.4 to 38.7, pain behavior decreased from 54.5 to 45, and pain interference was found to be 55.4 as compared to 44.7, all being statistically significant (p=0.000).
Conclusion:
Immediate TMR at time of amputation represents a meaningful intervention in improving pain outcomes for patients undergoing lower extremity amputation.
