Targeted muscle reinnervation in the pediatric population

Abstract

Background

Extremity amputation due to traumatic or oncologic etiology in the pediatric population confers reduced quality of life, psychosocial trauma, and chronic pain in the form of neuroma, and residual and/or phantom limb pain. Several techniques have been described with inconsistent efficacy, yet little is available prophylactically. The advent of targeted muscle reinnervation (TMR) has shown to have strong outcomes for this purpose in adults, affording aberrant nerves an adequate growth path. This study aims to describe our experiences with using TMR in a previously undescribed pediatric cohort.

Methods

TMR consisted of isolation of major residual nerves following surgical amputation. Residual nerves undergo microsurgical coaptation to motor nerves innervating remaining regional stump-muscles. Patients are followed post-operatively for development of pain and prosthetic usage.

Results

Two subjects were identified. The first was a 17-year-old female who suffered from fulminant liver failure and subsequent bilateral lower extremity necrosis necessitating bilateral below knee amputation (BKA). She concomitantly underwent TMR to both limbs. The second was a 12-year-old male with Ewing's sarcoma of the femur who previously underwent femoral resection and allograft/autograft reconstruction. On recurrence, above knee amputation (AKA) was conducted with concomitant TMR. On 16- and 12-month follow-up, respectively, both patients demonstrate use of prosthetic devices and report no pain, without the usage of pain medications.

Conclusion

TMR is feasible in the pediatric population. This intervention may warrant consideration in pediatric patients who are undergoing amputation for a variety of etiologies and can effectively serve to mitigate risk of neuroma formation and residual or phantom limb pain.