Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees

Pet, Mitchell A.; Ko, Jason H.; Friedly, Janna; Smith, Douglas G.

doi:10.1097/bot.0000000000000337

Cited by 40 publications

(29 citation statements)

References 15 publications

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“…Traditionally, traction neurectomy is performed at the time of amputation; however this results in a neuroma as the transected axons attempt to regenerate. 7 Numerous surgical techniques have been proposed 8 including excision of the neuroma and burying the nerve in muscle, 9 bone, [10][11][12] or vein, 13,14 and coaptation of two nerve ends. 15,16 To date, no method provides consistently effective relief of neuroma-related postamputation pain.…”

Section: Management Of Postamputation Pain Through Surgical Innovationmentioning

confidence: 99%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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Background We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. Methods Our TMR cohort was compared to a cross‐sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient‐Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. Results Thirty‐one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow‐up (mean follow‐up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159‐10.55; P = .015), 5.896 (95%CI 0.492‐11.30; P = .033), and 7.435 (95%CI 1.797‐13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528‐10.42; P = .031), 6.195 (95%CI 0.705‐11.69; P = .028), and 6.816 (95%CI 1.438‐12.2; P = .014), respectively. Fifty‐six percent took opioids before amputation compared to 22% at 1 year postoperatively. Conclusions Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee‐centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

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Section: Management Of Postamputation Pain Through Surgical Innovationmentioning

confidence: 99%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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“…Removing the neuroma eliminates PLP [73]. However, 42% of the patients redevelop a symptomatic neuroma and persistent pain within 37 months [74]. Therefore, while important, neurectomy alone is not the optimal long-term PLP treatment.…”

Section: Neuromasmentioning

confidence: 99%

Can phantom limb pain be reduced/eliminated solely by techniques applied to peripheral nerves?

Kuffler

2019

Journal of Neurorestoratology

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About 0.5% of the US population (1.7 million) is living with a lost limb and this number is expected to double by 2050. This number is much higher in other parts of the world. Within days to weeks of an extremity amputation, up to 80% of these individuals develop neuropathic pain presenting as phantom limb pain (PLP). The level of PLP increases significantly by one year and remains chronic and severe for about 10% of individuals. PLP has a serious negative impact on individuals’ lives. Current pain treatment therapies, such pharmacological approaches provide limited to no pain relief, some other techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) reduce or block PLP, but none produces long-term pain suppression. Therefore, new drugs or novel analgesic methods must be developed that prevent PLP from developing, or if it develops, to reduce the level of pain. This paper examines the potential causes of PLP, and present techniques used to prevent the development of PLP, or if it develops, to reduce the level of pain. Finally it presents a novel technique being developed that eliminates/reduces chronic neuropathic pain and which may induce the long-term reduction/elimination of PLP.

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“…Only two case series have been published on the outcomes of a surgical method that is most commonly used in clinical practice when treating symptomatic stump. 15,19 Traction neurectomy is the technique of gently pulling on the affected nerve before dissecting it proximally and allowing the tension to retract the severed nerve back up into soft tissue with the hope that the absence of pressure on the distal end of the nerve will be sufficient to prevent neuroma formation. The authors' experience is that the method of nerve cutting can vary according to clinician's choice.…”

Section: Traction Neurectomymentioning

confidence: 99%

“…Pet and colleagues demonstrated that neuroma excision alone with traction neurectomy provides slightly better outcomes within the same time frame so it is difficult to assess whether it is the vein implantation or the actual excision of the neuroma that is the determining factor in this respect. 15 This method of vein implantation is only feasible with superficial nerves and veins as using larger, deeper veins would increase the risk of thrombosis.…”

Section: Vein Implantationmentioning

confidence: 99%

“…19 Although this study demonstrated that neuroma excision followed by vein implantation reduces pain, we also know that traction neurectomy has the potential to reduce pain. 15 Studies comparing traction neurectomy and vein transplantation would therefore be useful in determining which provides the better outcome for the longest amount of time. Finally, despite being a randomised trial, this was still a small study which did not include stump neuromas and therefore it is not possible to generalise the results.…”

Section: Comparing Muscle and Vein Implantationmentioning

confidence: 99%

See 1 more Smart Citation

Peripheral Interventions for Painful Stump Neuromas of the Lower Limb

Poyntz¹,

Hacking²,

Dalal

et al. 2018

The Clinical Journal of Pain

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Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 40 publications

References 15 publications

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Can phantom limb pain be reduced/eliminated solely by techniques applied to peripheral nerves?

Peripheral Interventions for Painful Stump Neuromas of the Lower Limb

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