Peripheral Nerve Management in Extremity Amputations - 30/03/22

Doi : 10.1016/j.ocl.2022.01.002

John T. Richards, MD ^a,^b,^⁎ , Michael D. Baird, MD ^a,^{^{1
The designated authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S C.§105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S C. §101 defined a U.S. Government work as a work prepared by a military service member or employees of the U.S. Government as part of that person's official duties. The opinions or assertions contained in this article are the private views of the authors and are not to be construed as reflecting the views, policy, or positions of the Department of the Navy, Department of the Army, Department of Defense, nor the U.S. Government.}}, Scott M. Tintle, MD ^a,^{^{1
The designated authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S C.§105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S C. §101 defined a U.S. Government work as a work prepared by a military service member or employees of the U.S. Government as part of that person's official duties. The opinions or assertions contained in this article are the private views of the authors and are not to be construed as reflecting the views, policy, or positions of the Department of the Navy, Department of the Army, Department of Defense, nor the U.S. Government.}}, Jason M. Souza, MD ^c, Christopher H. Renninger, MD ^a,^b,^{^{1
The designated authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S C.§105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S C. §101 defined a U.S. Government work as a work prepared by a military service member or employees of the U.S. Government as part of that person's official duties. The opinions or assertions contained in this article are the private views of the authors and are not to be construed as reflecting the views, policy, or positions of the Department of the Navy, Department of the Army, Department of Defense, nor the U.S. Government.}}, Benjamin K. Potter, MD ^a,^{^{1
The designated authors are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S C.§105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S C. §101 defined a U.S. Government work as a work prepared by a military service member or employees of the U.S. Government as part of that person's official duties. The opinions or assertions contained in this article are the private views of the authors and are not to be construed as reflecting the views, policy, or positions of the Department of the Navy, Department of the Army, Department of Defense, nor the U.S. Government.}}
^a Department of Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
^b Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
^c Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

^∗Corresponding author. 22 S. Greene Street, Baltimore, MD 21201.22 S. Greene StreetBaltimoreMD21201

Résumé

The effective management of peripheral nerves in amputation surgery is critical to optimizing patient outcomes. Nerve-related pain after amputation is common, maybe a source of dissatisfaction and functional impairment, and should be considered in all amputees presenting with pain and dysfunction. While traction neurectomy or transposition has long been the standard of care, both regenerative peripheral nerve interface (RPNI) and targeted muscle reinnervation (TMR) have emerged as promising techniques to improve neuroma-related and phantom pain. A multi-disciplinary and multi-modal approach is essential for the optimal management of amputees both acutely and in the delayed or chronic setting.

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Keywords : Amputation, Neuroma, Phantom limb pain, Nerve injury, Targeted muscle reinnervation, Regenerative peripheral nerve interface