Annals of Vascular Surgery - Brief Reports and Innovations (Jun 2023)
Peripheral Nerve Reconstruction Using Placental Connective Tissue Matrix to Alleviate Phantom Limb Pain: A Case Report
Abstract
Background: Phantom limb pain (PLP) complicates approximately 85% of patients who undergo major limb amputation. Studies consistently show that PLP significantly affects mobility, ability to perform tasks for daily living, and overall quality of life. Surgical treatments for PLP have been described in modern literature and do seem to offer promising results. In addition, recent studies have also described the use of placental connective tissue matrix (PCTM) to promote wound healing and nerve repairs. Methods: A retrospective chart review identified eights patients who underwent peripheral nerve reconstruction (PNR). This reconstruction included targeted muscle reinnervation (TMR) and wrapping of the nerve collections with PCTM, for chronic and debilitating PLP. Patient charts were reviewed for demographics, risk factors, current functional status, self-reported pre- and post-operative pain scale ratings, pre- and post-operative PROMIS scores for pain intensity, and vascular quality of life (QOL) scores. Results: Prior to PNR, each patient had undergone nerve block which relieved their PLP. Pre-operative and post-operative scores and values were recorded in each of the aforementioned categories. The numeric rating scale for pain assessment showed an average pre-operative pain score of 9.01 (range 8-10), post-operative score of 3.4 (range 1-6; p<.0001), and 3-month follow up score of 1.69 (range 0.3-4; p <.0001). Pain intensity measured by the PROMIS Pain Intensity instrument showed an average pre-operative value of 4.19 (range 3.3-5), post-operative value of 2.21 (range 1.3-2.6, p <.0001). and 3 month follow up value of 1.8 (range 1.3-2; <.0001). Vascular QOL scores were recorded with higher scores indicating a better vascular QOL, and results showing an average pre-operative score of 10.38 (range 6-13), post-operative score of 18 (range 13-24; p 0.000368), and 3 month follow up score of 20.88 (range 19-27; p<.0001). Discussion: PLP can negatively affect a patient's well-being, functional status, daily activity, and overall quality of life. Historically, medical management has been considered first-line therapy, however this carries significant risks in patient populations with pertinent co-morbidities. PNR with PCTM can alleviate PLP, decrease pain medication use, and improve QOL.
