Does targeted nerve implantation reduce neuroma pain in amputees?
BACKGROUND
Symptomatic neuroma occurs in 13% to 32% of amputees, causing pain and limiting or preventing the use of prosthetic devices. Targeted nerve implantation (TNI) is a procedure that seeks to prevent or treat neuroma-related pain in amputees by implanting the proximal amputated nerve stump onto a surgically denervated portion of a nearby muscle at a secondary motor point so that regenerating axons might arborize into the intramuscular motor nerve branches rather than form a neuroma. However, the efficacy of this approach has not been demonstrated.


OBJECTIVE
We asked: Does TNI (1) prevent primary neuroma-related pain in the setting of acute traumatic amputation and (2) reduce established neuroma pain in upper- and lower-extremity amputees?


METHODS
We retrospectively reviewed two groups of patients treated by one surgeon: (1) 12 patients who underwent primary TNI for neuroma prevention at the time of acute amputation and (2) 23 patients with established neuromas who underwent neuroma excision with secondary TNI. The primary outcome was the presence or absence of palpation-induced neuroma pain at last followup, based on a review of medical records. The patients presented here represent 71% of those who underwent primary TNI (12 of 17) and 79% of those who underwent neuroma excision with secondary TNI (23 of 29 patients) during the period in question; the others were lost to followup. Minimum followup was 8 months (mean, 22 months; range, 8-60 months) for the primary TNI group and 4 months (mean, 22 months; range, 4-72 months) for the secondary TNI group.


RESULTS
At last followup, 11 of 12 patients (92%) after primary TNI and 20 of 23 patients (87%) after secondary TNI were free of palpation-induced neuroma pain.


CONCLUSIONS
TNI performed either primarily at the time of acute amputation or secondarily for the treatment of established symptomatic neuroma is associated with a low frequency of neuroma-related pain. By providing a distal target for regenerating axons, TNI may offer an effective strategy for the prevention and treatment of neuroma pain in amputees.
Division of Plastic and Reconstructive Surgery, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359798, Seattle, WA, 98195, USA, Mitchell.Pet@gmail.com.
Mitchell A
MA
Pet
Jason H
JH
Ko
Janna L
JL
Friedly
Pierre D
PD
Mourad
Douglas G
DG
Smith
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000534:rehabilitation*; D000672:Amputation Stumps / Q000294:innervation / Q000601:surgery*; D000674:Amputees / Q000534:rehabilitation*; D001134:Arm Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D016067:Nerve Transfer; D009463:Neuroma / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010591:Phantom Limb / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult