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Amputation may improve outcomes in select patients with brachial plexus injuries

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Amputation may improve outcomes in select patients with brachial plexus injuries



Source/Disclosures


Disclosures:
Shin reports no relevant financial disclosures.


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Patients with brachial plexus injuries who underwent amputation had decreased mechanical pain, increased employment rates and a high rate of postoperative satisfaction, according to published results.

“Amputation is an effective treatment for select patients with brachial plexus injuries for whom surgical reconstruction is unsuccessful,” Alexander Y. Shin, MD, of the Mayo Clinic, told Healio. “Patients who underwent amputation reported decreased mechanical pain, increased employment rates and a high rate of satisfaction following surgery. In amputees with sufficient nonintuitive electromyographic signals, myoelectric prostheses allow for terminal grasp/release and are associated with high rates of prosthesis use.”

Shin and colleagues retrospectively reviewed demographics, injury and reconstruction details, amputation characteristics, outcomes and complications of 32 patients with brachial plexus injuries who underwent elective upper-extremity amputation between June 2000 and June 2020. Researchers also assessed prosthesis use and myoelectric prosthesis function.

Alexander Y. Shin

Alexander Y. Shin

Among 29 patients with pan-plexus injuries, one patient with a partial C5-sparing pan-plexus injury, one patient with a lower-trunk with lateral cord injury and one patient with a lower-trunk injury, researchers identified 18 transhumeral amputations, 12 transradial amputations and two wrist disarticulations. Researchers noted 10 patients were fitted for a myoelectric prosthesis with electromyographic signal control from muscles not normally associated with the intended function.

Results showed a decrease in average VAS pain scores from 4.8 pre-amputation to 3.3 post-amputation for the myoelectric prosthesis group and from 5.4 to 4.4 for the non-myoelectric prosthesis group. Researchers also found a decrease in average DASH questionnaire scores from 35 pre-amputation to 30 post-amputation for the myoelectric prosthesis group and from 43 to 40 for the non-myoelectric prosthesis group. However, researchers noted the decrease was not significant.

Researchers found patients were more likely to be employed following amputation than they were before amputation, and no patient expressed regret about undergoing amputation. Regular use of the prosthesis was reported in 100% of patients in the myoelectric prosthesis group vs. 29% of patients with a traditional prosthesis, according to results. Researchers noted useful functional terminal grasp/release was reported by all patients in the myoelectric prosthesis group.

“This study presents a paradigm shift from stigma that amputation for brachial plexus injury patients represented a failure of surgical treatment, to amputation being a treatment option in a select group of patients,” Shin said. “Although amputation and myoelectric prosthetic (MEP) fitting are currently reserved for patients with brachial plexus injuries that are refractory to modern reconstructive techniques, continued improvements in prosthetic technology may allow for MEPs to facilitate a degree of terminal extremity control unachievable through reconstructive surgery for pan-plexus injuries.”