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Targeted Muscle Reinnervation for the Amputee: Updates on a Multi-cohort Analysis
J. Byers Bowen, MD
Corinne Wee
Ian Valerio, MD
Ohio State University
2017-02-15
Presenter: Byers Bowen
Affidavit:
Greg Pearson, MD
Director Name: Gregory D. Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Targeted Reinnervation (TR) is an operation that transfers transected peripheral nerves to muscle motor nerves and has been shown to reduce pain symptoms associated with amputation. This study seeks to determine the success of TR in preventing and treating symptomatic neuroma and phantom limb pain (NPLP). Each patient is followed for one year. Adult subjects' symptoms, functionality and satisfaction are measured by the Patient Reported Outcomes Measurement Information System (PROMIS) questionnaire. To date, we have performed TR on 35 patients. 28 of these patients received primary TR, undergoing TR at the time of amputation. Amputation was necessitated for various reasons, including: 12 patients with oncologic disease, 7 patients with skeletal trauma, and 6 patients with chronic osteomyelitis. Follow-up data at 12 months post-TR is available for 9 patients; all subjects have denied NPLP at 12 months follow-up. 22 subjects reported phantom limb pain and 2 subjects reported neuroma pain at their 1-month follow-up; all except one patient have reported improvement (or resolution) in this pain at or before their 6-month follow-up visit. In addition to its contribution to advancing prosthetic use, primary TR can assist in accelerating recovery by eliminating an additional operation and reducing pain symptoms. Delayed TR for the treatment of painful neuroma has also shown TR to be an effective treatment for NPLP that will help amputees regain functionality. Our results suggest that targeted reinnervation is an effective method to prevent and treat painful neuroma and phantom limb pain symptoms that often affect amputees.
