Berberoglu Ipek, Kemp Stephen W P, Hooper Rachel C
Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48103.
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI.
Plast Reconstr Surg. 2025 Jul 15. doi: 10.1097/PRS.0000000000012312.
Challenges in chronic pain management among post-amputation oncology patients have led to a shift in treatment paradigms. Regenerative Peripheral Nerve Interface (RPNI) has shown promise in attenuating neuropathic pain following traumatic major limb amputations. This study evaluates the utility of prophylactic RPNI among oncology patients requiring major upper and lower extremity amputation. The primary outcome is to evaluate the effectiveness of prophylactic RPNI in preventing symptomatic neuromas among oncology patients.
A retrospective review was conducted for patients with bone and soft tissue tumors who underwent major limb amputation at a single academic institution between 2010-2023. Patients who underwent prophylactic RPNI (N=27) were compared with a control group (N=35). Outcomes included preoperative pain, postoperative neuroma formation, phantom limb pain (PLP), and chronic opioid use. Statistical analysis was performed using the Chi-Squared test with GraphPad Prism 10.
Twenty-seven oncology patients (70.4% male, mean age 49.8 years) underwent amputation with prophylactic RPNI. The mean follow-up was 26.3 months (range: 3-58.5 months). The RPNI group included 9 upper and 18 lower extremity amputations. There were no symptomatic neuromas among the RPNI patients. In contrast, symptomatic neuromas were identified among 28.6% of the controls. At 12 months postoperatively, 91.3% of RPNI patients reported "no" or "mild" PLP compared to 70.8% of controls. Additionally, 90% of RPNI patients discontinued opioids within 6 months, compared to 50% of controls.
Prophylactic RPNI at the time of major limb amputation for oncology patients is associated with a substantial reduction in pain and opioid use.
截肢后肿瘤患者慢性疼痛管理面临的挑战导致了治疗模式的转变。再生周围神经接口（RPNI）在减轻创伤性大肢体截肢后的神经性疼痛方面显示出前景。本研究评估预防性RPNI在需要进行上下肢大截肢的肿瘤患者中的效用。主要结局是评估预防性RPNI在预防肿瘤患者出现症状性神经瘤方面的有效性。
对2010年至2023年期间在单一学术机构接受大肢体截肢的骨与软组织肿瘤患者进行回顾性研究。将接受预防性RPNI的患者（N = 27）与对照组（N = 35）进行比较。结局指标包括术前疼痛、术后神经瘤形成、幻肢痛（PLP）和慢性阿片类药物使用情况。使用GraphPad Prism 10进行卡方检验进行统计分析。
27例肿瘤患者（70.4%为男性，平均年龄49.8岁）接受了预防性RPNI截肢手术。平均随访时间为26.3个月（范围：3 - 58.5个月）。RPNI组包括9例上肢截肢和18例下肢截肢。RPNI患者中未出现症状性神经瘤。相比之下，对照组中有28.6%出现了症状性神经瘤。术后12个月时，91.3%的RPNI患者报告“无”或“轻度”PLP，而对照组为70.8%。此外，90%的RPNI患者在6个月内停用了阿片类药物，而对照组为50%。
肿瘤患者大肢体截肢时进行预防性RPNI与疼痛和阿片类药物使用的大幅减少相关。
