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Post amputation pain is a debilitating condition that affects almost 60% of transfemoral amputees.
In this study,
preemptive coaptation and collagen nerve wrapping has been related to the depiction
of the visual analog pain scores, neuroma formation and phantom symptoms. Here,
methods have been efficiently compared with traction neurectomy.
Post amputation
pain is a debilitating condition that affects almost 60% of transfemoral amputees.
Recent appreciation for the contribution of peripheral nerve derangement to the
development of post amputation pain has resulted in focus on the role of nerve
reconstruction in preventing pain after amputation. To propose a method
involving tibial and common peroneal nerve coaptation at the time of
amputation, as a means to prevent residual limb pain and phantom sequelae
resulting from neuroma formation.
Between May 2014
and May 2015, 17 patients underwent transfemoral amputation and nerve
management through either (1) common peroneal nerve-to- tibial nerve coaptation
and collagen nerve wrapping or (2) traction neurectomy alone. Visual analog
scores (VAS) for pain, analgesic requirements, neuroma formation, phantom
pain/sensations, and ambulatory status were compared between cohorts.
Six patients
underwent nerve coaptation/collagen nerve wrapping, whereas 11 underwent
traction neurectomy. At 2 months, VAS scores were similar between cohorts (3 vs
3.82; P = .88); however, neuroma (0% vs 36.3%; P = .24) and phantom pain (0%
and 54.5%; P = .03) were significantly lower after coaptation. After 6 months,
VAS scores (0.75 vs 5.6; P = .02) as well as neuroma (0% vs 54.5%; P = .03) and
phantom pain (0% vs 63.6%; P = .01) remained lower among patients who underwent
coaptation. At follow-up, 67% of coaptation patients were ambulating with a
prosthesis vs 9% of neurectomy patients (P = .01).
Preemptive
coaptation and collagen nerve wrapping is associated with lower VAS pain
scores, phantom symptoms, and neuroma formation, with higher ambulation rates
after 6 months when compared with traction neurectomy alone.
Neurosurgery
Prevention of Painful Neuroma and Phantom Limb Pain After Transfemoral Amputations Through Concomitant Nerve Coaptation and Collagen Nerve Wrapping.
Economides JM et al.
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