<< Back to the abstract archive
Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces Options During Free Tissue Transfer: A Case Series
Michael Wells, James Gatherwright
Case Western Reserve University School of Medicine
2021-02-15
Presenter: Michael Wells
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: James Gatherwright
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Post-amputation/nerve pain is a potentially chronic and devastating sequelae of traumatic injury, typically requiring a multi-disciplinary approach including orthopedic and plastic surgery with free flap reconstruction. To this end, we discuss alterations in microsurgical technique which allow for neurotization, targeted muscle reinnervation (TMR) and/or vascularized regenerative peripheral nerve interfaces (RPNI).
Case Presentation:
Five patients underwent neurotization, TMR and/or RPNI after traumatic injury. The first patient reported chronic sural nerve pain and underwent a free TMR in which the transected sural nerve was connected to the obturator nerve. The second patient was treated with a vascularized, free RPNI using vastus lateralis from an anterolateral thigh (ALT) flap to provide coverage and concomitant muscle wrap around the proximal median nerve repair. The third patient underwent a neurotization of the saphenous nerve and RPNI using muscle of the lateral femoris cutaneous nerve (LFCN) harvested form an ALT flap and a portion of the vastus lateralis for nerve coverage. The fourth patient had two branches of the dorsal sensory radial nerve neurotized to two branches of the LFCN associated with an ALT flap for soft tissue coverage. The fifth patient had ulnar nerve neurotized to the descending thoracodorsal nerve of a split latissimus dorsi transfer.
There were no complications related to the nerve treatments and decreased pain was reported in all patients with mean follow-up of 2.6 months (range: 1-5 months).
Discussion:
Free flap neurotization, TMR, and RPNI for treatment of post-amputation/traumatic neuropathy has significant potential for expanding current treatment of neuropathic pain.
