A recent study reported outcomes of targeted muscle reinnervation (TMR) during amputation surgery in children and young adults at Nationwide Children’s Hospital. TMR transfers transected nerves to nearby motor nerves to promote healing and prevent neuroma formation and phantom limb pain.
The presence of symptomatic post-operative neuromas, phantom limb pain, residual limb pain, and narcotic, neuromodulator, and prosthetic use were assessed and noted in the patients’ medical charts at post-operative visits with the plastic and reconstructive surgery and orthopedic oncology clinical providers at one month, one to three months, three to six months, and 12 months.
A follow-up phone survey was conducted assessing pediatric Patient Reported Outcomes Measurement Information System (PROMIS) metrics adapted to assess residual limb and phantom limb pain: The Numerical Pain Scale, Pain Behavior, Pain Interference, Pain Quality—Affective, and Pain Quality—Sensory.
Nine patients, seven males and two females with an average age of 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 phantom limb pain and residual limb pain were nearly one standard deviation lower than the United States general pediatric population. One patient developed a symptomatic neuroma one year after surgery.
Compared with an adult patient sample, the studied patients 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.
The open-access study, “Targeted muscle reinnervation for limb amputation to avoid neuroma and phantom limb pain in patients treated at a pediatric hospital,” was published in Plastic & Reconstructive Surgery.
