Faculty of Medicine

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    NO PAIN IS A PATIENT’S GAIN – A REVIEW OF SURGICAL TECHNIQUES FOR PREVENTION AND TREATMENT OF POSTAMPUTATION PAIN
    (Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022)
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    Regardless of the cause, major lower limb amputation is a life-changing event and accompanied by pain it has a great impact on patients’ quality of life. Over the years many pharmacological and surgical treatments have been tried to manage residual limb pain and phantom limb pain, but they were either unsuccessful or did not apply to all patients. The aim of this review paper was to describe the current modalities of treatment of postamputation pain and the opportunity to use surgical techniques as prophylactic. More than 150 surgical interventions have been described in the literature: traction neurectomy, nerve capping, end-to-end nerve coaptation, nerve transposition, etc. New and efficient techniques are regenerative peripheral nerve interface and targeted muscle reinnervation initially described for bioprosthetic control. Results from recent studies have shown that these techniques can be used for treatment, but also in a prophylactic manner, which can only be of benefit for the patient.
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    Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations
    (Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2022-04-22)
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    Srbov, Blagoja
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    Tusheva, Sofija
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    Jovanoski, Tomislav
    Regenerative peripheral nerve interface (RPNI) is a relatively new surgical technique to manage neuromas and phantom pain after limb amputation. This study evaluates prophylactic RPNI efficacy in managing post-amputation pain and neuroma formation in amputees compared with patients in which lower limb amputation was performed without this procedure. We included 28 patients who underwent above the knee amputation (AKA) or below the knee amputation (BKA) for severe soft tissue infection from July 2019 till December 2020. All patients had insulin-dependent diabetes. The patients were divided into two groups, 14 patients with primary RPNI and 14 patients without. We analyzed the demographic data, level of amputation, number of RPNIs, operative time, postoperative complications and functional outcome on the defined follow up period. The mean patient age was 68.6 years (range 49-85), 19 (67.9 %) male and 9 (32.1 %) female patients. In this study 11 (39.3 %) AKA and 17 (60.7 %) BKA were performed. Overall, 37 RPNIs were made. The mean follow-up period was 49 weeks. PROMIS T-score decreased by 15.9 points in favor for the patients with RPNI. The VAS score showed that, in the RPNI group, all 14 patients were without pain compared to the group of patients without RPNI, where the 11 (78.6 %) patients described their pain as severe. Patients with RPNI used prosthesis significantly more (p < 0.005). Data showed significant reduction in pain and high patient satisfaction after amputation with RPNIs. This technique is oriented as to prevent neuroma formation with RPNI surgery, performed at the time of amputation. RPNI surgery did not provoke complications or significant lengthening of operative time and it should be furthermore exploited as a surgical technique.