Why Treat When You Can Prevent? RPNI Is a Beneficial Prophylactic Surgical Procedure in Major Lower Limb Amputations
Gordana Georgieva, MD, Blagoja Srbov, MD, Sofija Tusheva, MD, Katerina Jovanovska, MD, Stefania Azmanova Mladenovska, MD, Bisera Nikolovska, MD PhD and Sofija Pejkova, MD PhD, University Clinic for Plastic and Reconstructive Surgery, Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of
Introduction: Phantom limb pain (PLP) and Residual limb pain (RLP) are well known entities occurring after limb amputation treated with a variety of conservative and surgical modalities. Although there are new and effective surgical procedures that can be used in a prophylactic manner, they are still underutilized. The aim of this study is to show the efficacy and benefit of Regenerative Peripheral Nerve Interfaces (RPNIs) as a surgical procedure during major lower limb amputation.
Material and Methods: Our study included 29 patients with elective lower limb major amputation that had RPNIs as a prophylactic procedure. Seventeen patients had AKA and 12 patients had BKA. We analyzed the demographics, operative time, postoperative complications and postoperative pain using VAS and PROMIS score.
Results: The results showed male predominance (76%) with average patient age of 70 years. Most of the patients were diabetics, 28% had peripheral artery disease and only one patient had limb amputation because of recurrent sarcoma. More than 80% of the patients had more than two comorbidities (renal failure, cardiovascular disease, history of ischemic stroke). A total of 71 RPNIs were made. The operative time was only slightly lengthened (7-9minutes per RPNI). Postoperatively 4 patients had complications that required revision surgery (2 partial skin necrosis, 1 hematoma and 1 infection). The follow up period was up to 24 weeks. Five patients died in the first month due to their comorbidities, not related to the surgery. Ninety-two percent of the patients reported significantly pain reduction first week post amputation and no opioid use was noted. On the eight week of the follow up, all of the patients were pain free and Tinnel sign was also negative. The main challenge in these patients is managing their comorbidities.
Conclusion: Plastic surgeons, especially ones focusing on nerve management are emerging to establish effective prophylactic procedure preventing PLP. Prevention is the best cure and RPNI is a technique that should be taken into account considering the slightly prolonged operative time, low complication rate and low postoperative pain.
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