Challenges and Potential in Targeted Muscle Reinnervation in Pediatric Amputees. Pediatrics 2022 Jan 01;149(1)
Date
12/31/2021Pubmed ID
34966922DOI
10.1542/peds.2021-051010Scopus ID
2-s2.0-85123968552 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
Targeted muscle reinnervation (TMR) is a powerful new tool in preventing and treating residual limb and phantom limb pain. In the adult population, TMR is rapidly becoming standard of care; however, there is a paucity of literature regarding indications and outcomes of TMR in the pediatric population. We present 2 cases of pediatric patients who sustained amputations and the relevant challenges associated with TMR in their cases. One is a 7-year-old patient who developed severe phantom and residual limb pain after a posttraumatic above-knee amputation. He failed pharmacologic measures and underwent TMR. He obtained complete relief of his symptoms and is continuing to do well 1.5 years postoperatively. The other is a 2-year-old boy with bilateral wrist and below-knee amputations as sequelae of sepsis. TMR was not performed because the patient never demonstrated evidence of phantom limb pain or symptomatic neuroma formation. We use these 2 cases to explore the challenges particular to pediatric patients when considering treatment with TMR, including capacity to report pain, risks of anesthesia, and cortical plasticity. These issues will be critical in determining how TMR will be applied to pediatric patients.
Author List
Vial B, Lieb M, Pysick H, Hettinger P, Rusy L, Hoben GAuthors
Gwendolyn M B Hoben MD Assistant Professor in the Plastic Surgery department at Medical College of WisconsinLynn M. Rusy MD Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Amputation StumpsAmputees
Child
Child, Preschool
Electromyography
Humans
Male
Muscle, Skeletal
Nerve Regeneration
Nerve Transfer
Phantom Limb
