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Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital

Amputees frequently experience chronic neuroma-related residual limb and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) transfers transected nerves to nearby motor nerves to promote healing and prevent neuroma formation and PLP. The purpose of this study was to report outcomes of TMR i...

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Autores principales: Bjorklund, Kim A., Alexander, John, Tulchin-Francis, Kirsten, Yanes, Natasha S., Singh, Satbir, Valerio, Ian, Klingele, Kevin, Scharschmidt, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101300/
https://www.ncbi.nlm.nih.gov/pubmed/37063502
http://dx.doi.org/10.1097/GOX.0000000000004944
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author Bjorklund, Kim A.
Alexander, John
Tulchin-Francis, Kirsten
Yanes, Natasha S.
Singh, Satbir
Valerio, Ian
Klingele, Kevin
Scharschmidt, Thomas
author_facet Bjorklund, Kim A.
Alexander, John
Tulchin-Francis, Kirsten
Yanes, Natasha S.
Singh, Satbir
Valerio, Ian
Klingele, Kevin
Scharschmidt, Thomas
author_sort Bjorklund, Kim A.
collection PubMed
description Amputees frequently experience chronic neuroma-related residual limb and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) transfers transected nerves to nearby motor nerves to promote healing and prevent neuroma formation and PLP. The purpose of this study was to report outcomes of TMR in a series of children and young adults treated at a pediatric hospital. METHODS: Patients undergoing major limb amputation with TMR were included with minimum one year follow-up and completed questionnaires. Primary clinical outcomes included incidence of symptomatic neuromas, PLP, residual limb pain, narcotic use, and neuromodulator use. A follow-up phone survey was conducted assessing five pediatric Patient Reported Outcomes Measurement Information System (PROMIS) metrics adapted to assess residual limb and PLP. RESULTS: Nine patients (seven male and two female patients, avg. age = 16.83 ± 7.16 years) were eligible. Average time between surgery and phone follow-up was 21.3 ± 9.8 months. Average PROMIS Pediatric t-scores for measures of pain behavior, interference, quality—affective, and quality—sensory for both PLP and residual limb pain were nearly 1 standard deviation lower than the United States general pediatric population. One patient developed a symptomatic neuroma 1 year after surgery. CONCLUSIONS: Compared with an adult patient sample reported by Valerio et al, our TMR patients at Nationwide Children’s Hospital (NCH) showed similar PLP PROMIS t-scores in pain behavior (50.1 versus 43.9) and pain interference (40.7 versus 45.6). Both pediatric and adult populations had similar residual limb pain including PROMIS pain behavior (36.7 adult versus 38.6 pediatric) and pain interference (40.7 adult versus 42.7 pediatric). TMR at the time of amputation is feasible, safe, and should be considered in the pediatric population.
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spelling pubmed-101013002023-04-14 Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital Bjorklund, Kim A. Alexander, John Tulchin-Francis, Kirsten Yanes, Natasha S. Singh, Satbir Valerio, Ian Klingele, Kevin Scharschmidt, Thomas Plast Reconstr Surg Glob Open Peripheral Nerve Amputees frequently experience chronic neuroma-related residual limb and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) transfers transected nerves to nearby motor nerves to promote healing and prevent neuroma formation and PLP. The purpose of this study was to report outcomes of TMR in a series of children and young adults treated at a pediatric hospital. METHODS: Patients undergoing major limb amputation with TMR were included with minimum one year follow-up and completed questionnaires. Primary clinical outcomes included incidence of symptomatic neuromas, PLP, residual limb pain, narcotic use, and neuromodulator use. A follow-up phone survey was conducted assessing five pediatric Patient Reported Outcomes Measurement Information System (PROMIS) metrics adapted to assess residual limb and PLP. RESULTS: Nine patients (seven male and two female patients, avg. age = 16.83 ± 7.16 years) were eligible. Average time between surgery and phone follow-up was 21.3 ± 9.8 months. Average PROMIS Pediatric t-scores for measures of pain behavior, interference, quality—affective, and quality—sensory for both PLP and residual limb pain were nearly 1 standard deviation lower than the United States general pediatric population. One patient developed a symptomatic neuroma 1 year after surgery. CONCLUSIONS: Compared with an adult patient sample reported by Valerio et al, our TMR patients at Nationwide Children’s Hospital (NCH) showed similar PLP PROMIS t-scores in pain behavior (50.1 versus 43.9) and pain interference (40.7 versus 45.6). Both pediatric and adult populations had similar residual limb pain including PROMIS pain behavior (36.7 adult versus 38.6 pediatric) and pain interference (40.7 adult versus 42.7 pediatric). TMR at the time of amputation is feasible, safe, and should be considered in the pediatric population. Lippincott Williams & Wilkins 2023-04-13 /pmc/articles/PMC10101300/ /pubmed/37063502 http://dx.doi.org/10.1097/GOX.0000000000004944 Text en Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Peripheral Nerve
Bjorklund, Kim A.
Alexander, John
Tulchin-Francis, Kirsten
Yanes, Natasha S.
Singh, Satbir
Valerio, Ian
Klingele, Kevin
Scharschmidt, Thomas
Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title_full Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title_fullStr Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title_full_unstemmed Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title_short Targeted Muscle Reinnervation for Limb Amputation to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
title_sort targeted muscle reinnervation for limb amputation to avoid neuroma and phantom limb pain in patients treated at a pediatric hospital
topic Peripheral Nerve
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101300/
https://www.ncbi.nlm.nih.gov/pubmed/37063502
http://dx.doi.org/10.1097/GOX.0000000000004944
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