From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital and Harvard Medical School; and the Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center.
Plast Reconstr Surg. 2021 Feb 1;147(2):279e-283e. doi: 10.1097/PRS.0000000000007594.
Targeted muscle reinnervation is a contemporary technique designed to enhance an amputee's ability to operate a myoelectric prosthesis. This technique has been shown to decrease neuropathic pain, including neuroma and phantom limb pain. In certain amputations, especially forequarter and hindlimb levels, there may be no nearby recipient muscle sites, or the residual nerve may be too short to perform targeted muscle reinnervation. Applying the spare parts concept can help solve this problem by providing nerve autograft or additional muscle recipient sites within the spare parts flap for successful targeted muscle reinnervation surgery procedures. A retrospective review of all patients that underwent spare parts targeted muscle reinnervation reconstructions between 2016 and 2019 at two institutions was performed. Patients were assessed for healing, neuroma and phantom limb pain, and function. Twelve patients underwent targeted muscle reinnervation during spare parts reconstruction; eight were male and four were female. The mean patient age was 55.3 years (range, 16 to 72 years). For those with known soft-tissue deficit size, the surface area of the donor site spared by using spare parts reconstruction ranged from 216 to 856 cm2. None of the 12 patients subsequently experienced neuroma, and 75 percent had no phantom limb pain after 3 months. Three patients have obtained insurance-approved myoelectric prosthetics, and all three demonstrated intuitive control of targeted muscles. Using a spare parts reconstruction in conjunction with targeted muscle reinnervation may optimize reconstructive efforts in the setting of major limb amputations and aid in decreasing phantom limb and neuroma pain, and facilitate the possibility of functional prosthetic and/or myoelectric prosthesis use.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
靶向肌肉神经再支配是一种当代技术，旨在增强截肢者操作肌电假体的能力。该技术已被证明可减轻神经病理性疼痛，包括神经瘤和幻肢痛。在某些截肢中，特别是在上肢和下肢水平，可能没有附近的受肌部位，或者残留的神经太短，无法进行靶向肌肉神经再支配。应用备用零件概念可以通过在备用零件皮瓣内提供神经自体移植物或额外的肌肉受肌部位来解决这个问题，从而为成功的靶向肌肉神经再支配手术提供帮助。对 2016 年至 2019 年在两个机构接受备用零件靶向肌肉神经再支配重建的所有患者进行了回顾性研究。对患者的愈合、神经瘤和幻肢痛以及功能进行了评估。12 名患者在备用零件重建期间接受了靶向肌肉神经再支配；8 名男性，4 名女性。患者的平均年龄为 55.3 岁（范围 16 至 72 岁）。对于那些已知软组织缺损大小的患者，使用备用零件重建节省的供体部位表面积范围为 216 至 856cm2。12 名患者中没有一人随后出现神经瘤，75%的患者在 3 个月后没有幻肢痛。3 名患者获得了保险批准的肌电假体，所有 3 名患者都表现出对靶向肌肉的直观控制。在大肢体截肢的情况下，结合使用备用零件重建和靶向肌肉神经再支配可以优化重建工作，有助于减轻幻肢和神经瘤疼痛，并促进功能性假体和/或肌电假体的使用。
临床问题/证据水平：治疗性，IV。
