Improvements in Amputation and the Fitting of Prothesis

    There are many reasons someone would potentially lose a limb; be it from disease, an accident, or from partaking in armed conflict. This loss is never easy, and takes a complete retraining of behaviors. One thing that cannot be trained however is how your body reacts to the loss of the limb. Many people who have lost a limb experience phantom limb pain that stems from neuromas. These neuromas are cut nerve endings that are encased in scar tissue. In, “Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees,” Dumanian et al. looked into a possible treatment for these issues that plague amputees. There had been a few treatments that had been created, but there had not been one that was proven to be consistently effective at treatment. Dumanian took a different approach from what had been previously done, instead he removed the terminal neuroma and then took the new end and implanted it into a nearby motor nerve. This was called “targeted muscle reinnervation,” and it was observed to lessen patients' phantom pain. With some more fine-tuning, patients could have even less pain.

    In, “Targeted Muscle Reinnervation for Prosthesis Optimization and Neuroma Management in the Setting of Transradial Amputation,” written by Pierrie et al., take the procedure by Dumanian and improve upon it. They make sure that their patients have enough soft tissue at the end of the amputated limb. They make sure that the donor and target nerves are similar enough, and reinforce the site of connection if they are not similar enough. Adipose flaps and synthetic grafts are used to help isolate the muscle signals of the newly connected nerves. Patients are then given a stump shrinker, and then given a simple prosthesis and simple terminal end device. The addition of quickly fitting patients with a simple prosthesis have helped improve limb edema and prosthetic utilization rates.

    It is impressive to see how this medical procedure has progressed as time has gone on. They were already able to lessen the phantom pain found in patients, and now they have been able to lessen the edema that patients might experience after an amputation. While they have helped improve the prosthetic utilization rates, I’m sure there are still more ways to improve upon it. Starting off with a simple prosthesis might be good, but giving a more complex prosthesis to patients as soon as possible might have improved results. Patients most likely had decent control over their limbs before amputation, so it would be safe to assume that they would be able to control a more complex prosthesis if they were given some time. Even if that were not the case, I’m sure there is some way that we could make the adjustment to a prosthesis easier than it is now.

Works Cited

Dumanian, G. A., Potter, B. K., Mioton, L. M., Ko, J. H., Cheesborough, J. E., Souza, J. M., Ertl, W. J., Tintle, S. M., Nanos, G. P., Valerio, I. L., Kuiken, T. A., Apkarian, A. V., Porter, K., & Jordan, S. W. (2019). Targeted muscle reinnervation treats neuroma and Phantom Pain in major limb amputees. Annals of Surgery, 270(2), 238–246. https://doi.org/10.1097/sla.0000000000003088

Pierrie, S. N., Gaston, R. G., & Loeffler, B. J. (2019). Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of Transradial amputation. The Journal of Hand Surgery, 44(6). https://doi.org/10.1016/j.jhsa.2018.11.019