Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
J Plast Reconstr Aesthet Surg. 2024 Jul;94:40-42. doi: 10.1016/j.bjps.2024.05.007. Epub 2024 May 10.
Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are used to prevent or treat neuromas in amputees. TMR for above-the-knee amputation (AKA) is most commonly performed through a posterior incision rather than the stump wound because recipient motor nerves are primarily located in the proximal third of the thigh. When preventative TMR is performed with concurrent AKA, a posterior approach requires intraoperative repositioning and an additional incision. The purpose of this study was to evaluate feasibility of TMR and operative times for nerve management performed through the wound compared to a posterior approach in AKA patients to guide surgical decision-making. Patients who underwent AKA with TMR between 2018-2023 were reviewed. Patients were divided into two groups: TMR performed through the wound (Group I) and TMR performed through a posterior approach (Group II). If a nerve was unable to undergo coaptation for TMR due to the lack of suitable donor motor nerves, RPNI was performed. Eighteen patients underwent AKA with nerve management were included from Group I (8 patients) and Group II (10 patients). TMR coaptations performed on distinct nerves was 1.5 ± 0.5 in Group I compared to 2.6 ± 0.5 in Group II (p = 0.001). Operative time for Group I was 200.7 ± 33.4 min compared to 326.5 ± 37.1 min in Group II (p = 0.001). TMR performed through the wound following AKA requires less operative time than a posterior approach. However, since recipient motor nerves are not consistently found near the stump, RPNI may be required with TMR whereas the posterior approach allows for more TMR coaptations.
靶向肌肉神经再支配（TMR）和再生周围神经接口（RPNI）用于预防或治疗截肢患者的神经瘤。对于膝上截肢（AKA），TMR 最常通过后入路进行，而不是残端伤口，因为接受运动神经主要位于大腿近端的前三分之一。当预防性 TMR 与同时进行的 AKA 一起进行时，后入路需要术中重新定位和额外的切口。本研究旨在评估通过伤口进行 TMR 和神经管理的可行性以及手术时间，与 AKA 患者的后入路进行比较，以指导手术决策。回顾了 2018-2023 年间接受 AKA 伴 TMR 的患者。患者分为两组：通过伤口进行 TMR（组 I）和通过后入路进行 TMR（组 II）。如果由于缺乏合适的供体运动神经，导致神经无法进行 TMR 吻合，则进行 RPNI。从组 I（8 例）和组 II（10 例）中纳入了 18 例接受 AKA 伴神经管理的患者。在组 I 中，对不同神经进行 TMR 吻合的次数为 1.5±0.5，而在组 II 中为 2.6±0.5（p=0.001）。组 I 的手术时间为 200.7±33.4 分钟，而组 II 为 326.5±37.1 分钟（p=0.001）。AKA 后通过伤口进行 TMR 所需的手术时间比后入路少。然而，由于接受运动神经并不始终靠近残端，因此 TMR 可能需要 RPNI，而后入路允许更多的 TMR 吻合。
