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Targeted Reinnervation for the Oncologic Amputee
Bowen JB, Wee CE, Kalik J, Valerio, IL
The Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
2016-01-31
Presenter: J. Byers Bowen, MD
Affidavit:
Gregory D. Pearson, MD
Director Name: Gregory D. Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: About 25% of major limb amputees will develop chronic localized symptomatic neuromas in the residual limb. Targeted Reinnervation (TR) is a surgical technique in which the native motor nerve of the target muscle is divided, and the amputated nerve is then transferred to a near by motor nerve. This neurorrhaphy reestablishes various functions of the amputated nerve to reduce pain symptoms.
Purpose: Previous studies demonstrate the effectiveness of TR in relieving chronic neuroma pain after amputation. This study seeks to evaluate the use of TR performed at the time of amputation as preventative measure for neuroma and phantom pain.
Methods: One pediatric (9 yo) patient underwent an above-knee amputation, one adult patient underwent a below-knee amputation, the other an arm amputation. All underwent TR at the time of amputation. Each subject will be followed for one year to evaluate symptoms of neuroma or phantom limb pain, patient satisfaction and functionality after TR. Adult subjects' progress will be measured by the Patient Report Outcomes Measurement Information System questionnaire, which is not validated for subjects under 18 years old.
Findings: 3/3 subjects denied neuroma pain post-amputation. All subjects initially reported phantom limb pain at their 2-week follow-up, but all three reported improvement in this pain at or before their 6-month follow-up visit, with one patient reporting improvement by 1 month.
Conclusion: Primary targeted reinnervation can prevent painful neuroma symptoms that often affect amputees. Performing TR at the time of amputation prevents an additional operation and can accelerate recovery by reducing pain.
