Primary Targeted Muscle Reinnervation after Below-Knee Amputation Is Not Associated with an Increased Risk of Major or Minor Surgical Complications: A Multi-Institutional, Propensity Score-Matched Analysis.

التفاصيل البيبلوغرافية
العنوان:	Primary Targeted Muscle Reinnervation after Below-Knee Amputation Is Not Associated with an Increased Risk of Major or Minor Surgical Complications: A Multi-Institutional, Propensity Score-Matched Analysis.
المؤلفون:	Shammas RL; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Azoury SC; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Sergesketter AR; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Lee HJ; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Poehlein E; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Othman SE; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Cason RW; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Levinson H; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Kovach SJ; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System., Mithani SK; From the Division of Plastic, Maxillofacial, and Oral Surgery and Department of Biostatistics and Bioinformatics, Duke University; and Plastic Reconstructive and Orthopaedic Surgery, University of Pennsylvania Health System.
المصدر:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2022 Sep 01; Vol. 150 (3), pp. 589-598. Date of Electronic Publication: 2022 Jul 06.
نوع المنشور:	Journal Article; Multicenter Study
اللغة:	English
بيانات الدورية:	Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 1306050 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1529-4242 (Electronic) Linking ISSN: 00321052 NLM ISO Abbreviation: Plast Reconstr Surg Subsets: MEDLINE
أسماء مطبوعة:	Publication: : Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Baltimore : Williams & Wilkins,
مواضيع طبية MeSH:	Amputation, Surgical/adverse effects , Amputation, Surgical/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications*/surgery, Humans ; Muscle, Skeletal/surgery ; Propensity Score ; Retrospective Studies ; Treatment Outcome
مستخلص:	Background: Targeted muscle reinnervation has emerged as a technique to reduce neuroma and phantom limb pain after below-knee amputation; however, the incidence of postoperative complications remains unknown. This multi-institutional study assessed the risk of postoperative complications among patients who underwent targeted muscle reinnervation at the time of below-knee amputation. Methods: Patients who underwent below-knee amputation with targeted muscle reinnervation were propensity score-matched 1:3 to patients who underwent below-knee amputation alone. Study outcomes included the incidence of major or minor complications within 60 days. Regression models were used to estimate the relative risk of major and minor complications. Results: Overall, 96 patients were matched, including 31 patients who had below-knee amputation with targeted muscle reinnervation and 65 who had below-knee amputation alone. In the matched sample, a higher incidence of major complications (29 percent versus 24.6 percent), readmission (25.8 percent versus 18.5 percent), and reoperation (19.4 percent versus 10.8 percent) was seen after both procedures compared with below-knee amputation alone. Patients who underwent both procedures displayed a higher incidence of minor complications (25.8 percent versus 20.0 percent), blood transfusion (22.6 percent versus 18.5 percent), and wound healing complications (45.2 percent versus 33.8 percent) and longer operative time (mean ± SD, 188.5 ± 63.6 minutes versus 88 ± 28.2 minutes). There was no statistically significant difference in the risk of major (relative risk, 1.20; 90 percent CI, 0.68, 2.11) or minor (relative risk, 1.21; 90 percent CI, 0.61, 2.41) complications between the two cohorts. Conclusions: Despite an increased incidence of postoperative complications, undergoing below-knee amputation with targeted muscle reinnervation does not confer a statistically significant increased risk of major or minor complications. Future studies are needed to delineate patient selection criteria when assessing the suitability of targeted muscle reinnervation at the time of major limb amputation. Clinical Question/level of Evidence: Therapeutic, III. (Copyright © 2022 by the American Society of Plastic Surgeons.)
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تواريخ الأحداث:	Date Created: 20220706 Date Completed: 20220902 Latest Revision: 20221207
رمز التحديث:	20231215
DOI:	10.1097/PRS.0000000000009441
PMID:	35791757
قاعدة البيانات:	MEDLINE

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تدمد:	1529-4242
DOI:	10.1097/PRS.0000000000009441