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http://dx.doi.org/10.5999/aps.2020.02180

Surgical prevention of terminal neuroma and phantom limb pain: a literature review  

Bogdasarian, Ronald N. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School)
Cai, Steven B. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School)
Tran, Bao Ngoc N. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School)
Ignatiuk, Ashley (Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School)
Lee, Edward S. (Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School)
Publication Information
Archives of Plastic Surgery / v.48, no.3, 2021 , pp. 310-322 More about this Journal
Abstract
The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms "phantom limb pain," "amputation neuroma," and "surgical prevention of amputation neuroma." Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a targetbased classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.
Keywords
Terminal neuroma; Phantom limb pain; Surgical prevention of phantom limb pain; Targeted muscle reinnervation; Targeted nerve implantation;
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