Abstract
Introduction. Contemporary combat limb injury is characterized by massive soft tissues and bone structures, which often makes it impossible to save the injured extremity and need for its amputation. However, a number of amputees have pain syndrome in the residual limb and cannot use prostheses.
Objective. To analyze local complications, causes of residual limb pain syndrome, and methods of their treatment.
Methods. We observed 285 combatants with residual limb pain syndrome after its combat injury, of which 151 (53%) had neuromas and 108 (38%) had heterotopic ossification and osteophytes. All individuals were male. The average age was 36.13±8.64 years. The intensity of the pain syndrome according to the Defense and Veterans Pain Rating Scale (DVPRS) ranged from 4 to 10 points.
Results. Treatment of persistent pain in the stump with analgesics was not effective. Denervation of neuromas using alcohol injections, performed in 69 (24.2%) patients, was effective in pain syndrome intensity up to 6 points on the DVPRS scale. Neuroma resection was effective in 77% of patients, but sensitization persisted in 23%. Recurrent pain syndrome with lower intensity was observed in 30% after neuroma resection, nerve stump compression with cautery and alcohol blockade. Addition these procedures with the nerve stump suture, reduced neuroma recurrences by up to 10%. The best results of surgical treatment of neuromas with pain syndrome of 6 points and more on the DVPRS scale were obtained after their resection and the use of regenerative peripheral nerve interface (RPNI) in 25 patients. These patients had no recurrence of pain syndrome within 2 months after surgery. Heterotopic ossification most often occurred in patients with mine-explosive injuries in the thigh stumps 2-6 months after limb amputation and recurrence after simple resection of osteophytes. After performing myodesis in 18 patients there was no recurrence of heterotopic ossification within a year of observation.
Conclusions. Neuromas of peripheral nerves and heterotopic ossification are the main causes of pain syndrome in late period after amputation in combatants with residual limbs. The most effective methods of surgical treatment of neuromas in residual limbs is neuroma resection and regenerative peripheral nerve interface. Myodesis prevents the formation of heterotopic ossification.