Prophylactic Regenerative Peripheral Nerve Interface Surgery in Pediatric Lower Limb Amputation Patients.

Area of Science:

• Orthopedic Surgery
• Pain Management
• Regenerative Medicine

Background:

• Chronic post-amputation pain affects up to 83% of pediatric limb loss patients.
• This pain leads to disability and reduced quality of life.
• Current treatments for pediatric post-amputation pain are often ineffective.

Purpose of the Study:

• To evaluate the prophylactic effect of Regenerative Peripheral Nerve Interface (RPNI) surgery on pediatric post-amputation pain.
• To assess if RPNI surgery reduces the incidence of symptomatic neuroma and phantom limb pain.
• To determine if RPNI surgery limits analgesic use in pediatric patients with limb loss.

Main Methods:

• Retrospective chart review of pediatric patients (ages 8-21) undergoing major lower limb amputation.
• Comparison between patients who received RPNI surgery and those who did not (controls).
• Analysis of neuroma pain, phantom limb pain scores, and analgesic use (MME/day, MQSIII).

Main Results:

• Seventy-nine percent of control patients developed chronic pain versus 21% of RPNI patients (P<0.001).
• Zero percent of RPNI patients developed clinical neuroma pain compared to 20% of controls (P<0.001).
• RPNI patients showed significantly decreased pain scores (P=0.007) and narcotic usage (P<0.01).

Conclusions:

• Prophylactic RPNI surgery shows promise in preventing symptomatic neuromas in pediatric amputees.
• RPNI surgery may help prevent the development of phantom limb pain in this population.
• RPNI surgery is a potential strategy to improve outcomes for pediatric limb loss patients.