Retrospective Evaluation of Targeted Muscle Reinnervation at the Time of Major Limb Amputation as a Means to Avoid Neuroma and Phantom Limb Pain in Patients Treated at a Pediatric Hospital
Kim A Bjorklund, MD, MEd, Nationwide Chidlren's Hospital/Ohio State University, Columbus, OH
Introduction: Amputees frequently suffer from chronic neuroma-related residual limb
and phantom limb pain (PLP). Targeted muscle reinnervation (TMR) transfers
transected nerves to nearby motor nerves to promote healing, 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 and Materials: 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 PROMIS metrics adapted to assess residual limb and PLP.
Results: Nine patients (7 male, 2 female, 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 to 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 vs 43.9) and pain interference (40.7 vs 45.6). Both
pediatric and adult populations had similar residual limb pain including PROMIS pain
behavior (36.7 adult vs 38.6 pediatric) and pain interference (40.7 adult vs 42.7
pediatric). TMR at the time of amputation is feasible, safe, and should be considered in
the pediatric population.
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