Agrawal Nikhil A, Gfrerer Lisa, Heng Marilyn, Valerio Ian L, Eberlin Kyle R
Massachusetts General Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2021 Jun 22;9(6):e3655. doi: 10.1097/GOX.0000000000003655. eCollection 2021 Jun.
Targeted muscle reinnervation and regenerative peripheral nerve interfaces are increasingly utilized strategies to mitigate phantom and residual limb pain in amputees. These interventions are successful, yet often imperfect in completely ameliorating neuropathic pain following amputation. Implantable peripheral nerve stimulators are another tool in the armamentarium for management of neuropathic pain. These devices have been utilized adjacent to the spinal cord and more recently in the extremities with good results, and there has been additional interest in their utility for nerve regeneration. In this case report, we present the first reported case in the readily available literature of combining contemporary peripheral nerve strategies with an implantable peripheral nerve stimulator for postamputation neuropathic pain. The patient is a 72-year-old man who presented with severe neuropathic pain following prior below knee amputation with an osseointegrated implant and regenerative peripheral nerve interfaces. The authors performed targeted muscle reinnervation with intra-operative placement of a peripheral nerve stimulator. He did well after the procedure, and his pain improved with activation of the device. The most symptomatic nerve is targeted with the nerve stimulator, and it is placed adjacent to the nerve transfer(s). Combining these contemporary techniques may lead to improved prosthetic use and quality of life for these patients.
靶向肌肉再支配和再生周围神经接口是越来越多地用于减轻截肢者幻肢痛和残肢痛的策略。这些干预措施是成功的，但在完全缓解截肢后的神经性疼痛方面往往并不完美。植入式周围神经刺激器是治疗神经性疼痛的另一种工具。这些设备已被用于脊髓附近，最近也在四肢使用，效果良好，人们对其在神经再生方面的效用也有了更多兴趣。在本病例报告中，我们展示了现有文献中首例将当代周围神经策略与植入式周围神经刺激器相结合用于截肢后神经性疼痛的病例。患者为一名72岁男性，此前接受了带骨整合植入物和再生周围神经接口的膝下截肢手术，术后出现严重的神经性疼痛。作者进行了靶向肌肉再支配，并在术中放置了周围神经刺激器。术后他情况良好，激活设备后疼痛有所改善。神经刺激器针对最有症状的神经，并放置在神经移位附近。结合这些当代技术可能会改善这些患者的假肢使用情况和生活质量。
