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Thinking Outside the Box - Spare Parts Surgery from Trauma to Oncology
Michael Larsen MD
Kyle Eberlin MD
Ian Valerio MD
Ohio State University
2018-02-15
Presenter: Michael T Larsen
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. 70% of this work is the resident's work, which is original.
Director Name: gregory pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
The treatment of certain extremity malignancies, infections, or traumas may require amputation of the extremity. Such treatment can leave a large soft tissue defect; furthermore, polytrauma patients may have additional defects. A "spare-parts" approach can be employed to reconstruct such defects, where needed tissues are harvested from the amputated appendage and transferred in a vascularized or non-vascularized fashion. Spare-part nerves can even be transferred to autograft nerve stumps to surrounding recipient muscles in a targeted reinnervation (TR) fashion. This study examines techniques and outcomes of spare-parts reconstruction for amputation defects.
Methods
A review of all patients that underwent spare-parts reconstruction between 2016-2018 at two institutions, was performed. Patients were followed to assess for healing, neuroma and phantom limb pain, and function.
Results
Ten patients underwent spare parts reconstruction during this period. For those with a soft tissue deficit, the surface area of donor site spared by using spare parts reconstruction ranged from 216 to 856 cm2. Defects reconstructed included fingertips, plantar surface, chest wall with open pleural space, chest soft tissue, and nerve gaps. None of the patients who underwent spare parts TR are currently experiencing neuroma or phantom limb pain. Three TR patients demonstrate intuitive control of myoelectric prostheses.
Conclusion
A proximal amputation can be a morbid procedure for a patient; however, employing a spare-parts reconstruction can avoid other donor sites. Furthermore, spare-parts targeted reinnervation may aid in decreasing phantom limb pain, neuroma pain, and may open up the possibility of a myoelectric prosthesis in the patient's future.
