Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol.
Adolescent
Adult
Aged
Aged, 80 and over
Amputation, Surgical
/ methods
Amputation Stumps
/ innervation
Bone Neoplasms
/ rehabilitation
Cohort Studies
Continuity of Patient Care
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Muscle, Skeletal
/ innervation
Neoplasms
/ rehabilitation
Nerve Transfer
/ methods
Osteosarcoma
/ rehabilitation
Patient Care Team
Phantom Limb
/ prevention & control
Sarcoma
/ rehabilitation
Young Adult
neuroma
pain management
phantom limb pain
residual limb pain
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
14
01
2019
revised:
14
05
2019
accepted:
25
05
2019
pubmed:
15
6
2019
medline:
20
8
2019
entrez:
15
6
2019
Statut:
ppublish
Résumé
We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. 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. 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. 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.
Sections du résumé
BACKGROUND
BACKGROUND
We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation.
METHODS
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
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
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.
Identifiants
pubmed: 31197851
doi: 10.1002/jso.25586
pmc: PMC7701996
mid: NIHMS1644654
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
348-358Subventions
Organisme : NCI NIH HHS
ID : P30 CA016058
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Wiley Periodicals, Inc.
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