Matthew L. Iorio

Background: Pain is a common experience in the phantom limb, residual limb, and other parts of the body following amputation. However, formal pain surveys typically do not differentiate between these different pain subtypes, leading to a lack of relevant data to clinically diagnose patients' pain and provide targeted treatment. Objective: To characterize the phantom limb, residual limb, and bodily pain experiences and quality of life of patients with major lower limb amputation and compare these to self‐evaluations of overall pain at time the survey, during the past month during rest, light daily activity, and maximal exertion to investigate prosthesis‐related pains. Design: Cross‐sectional within‐participant study. Setting: Institutional secondary care. Patients: Eighty three adults with unilateral transfemoral or transtibial amputation with socket prostheses or bone‐anchored limbs. Interventions: Not applicable. Main outcome measures: Overall, phantom limb, residual limb, and bodily pain evaluated at time of survey, averaged over past month, and during rest, light activity, and maximal activity. Results: Current and recalled residual limb pain intensity correlated with other pain subtypes for individuals with transfemoral socket prostheses ( p ≤ .023), but not transfemoral bone‐anchored limbs ( p ≥ .064). Residual limb pain consistently correlated with current and recalled overall pain ( p ≤ .037). More intense activity was correlated with higher pain intensity for individuals with transfemoral socket prostheses ( p < .001), but phantom limb and bodily pains did not increase between rest and walking for individuals with transfemoral bone‐anchored limbs ( p ≥ .063). Conclusions: Phantom limb, residual limb, and bodily pains contribute differently to the self‐evaluation of overall pain, impact on quality of life, and challenge completing daily activities. Pain subtypes also differed between activity levels for individuals using socket prostheses but less so for those with bone‐anchored limbs. Thus, pain subtypes should be evaluated simultaneously to provide a comprehensive assessment of patients' experiences with pain.

Lower limb amputation (LLA) secondary to trauma, oncologic, diabetic, and vascular disease represents a significant patient challenge in terms of restoring function to pre-injury levels. This can be secondary to wear and use of a prosthetic limb, as well as limitations in range of motion or chronic pain. This study aimed to review and discuss the available, and potentially soon-to-be-available, roles of artificial intelligence (AI) in extremity amputation care. Specifically, we discuss the current state of AI technology in LLA prevention, management, peripheral nerve injury treatment, and lower limb prosthesis design, as well as highlighting current advancements and the direction of these linked fields.

Recurrent laryngeal nerve injuries can occur during thyroid and neck procedures or similar interventions. Immediate nerve repair when possible is preferred to both faciliate the repair and allow timely recovery of the muscle. Here, we report a case of transected left recurrent laryngeal nerve repaired by allograft nerve interposition with excellent return of speaking and singing voice with vocal cord function. Laryngoscope, 135:1086–1089, 2025

Background: Common peroneal nerve (CPN) disruption is the most common lower extremity nerve injury and results in gait disturbances and sensory paresthesias. The goal of this study is to describe branching patterns and the intraneural topography of the CPN to facilitate operative planning in CPN reconstruction. Methods: The CPN and its distal motor and sensory branches were dissected in 6 lower leg cadavers. Branching patterns and distances were recorded with the fibular head as the landmark. Histological review of the nerve cross sections helped characterize the intraneural topography within the fibular tunnel. Results: The CPN distal branching patterns were highly variable. The tibialis anterior motor branch was found on average 9.6 cm distal to the fibular head. Despite the variable branching patterns, the fascicular topography of the CPN within the fibular tunnel was consistent. Proximal to the tunnel, the nerve has 3 major fascicles, which include the superficial peroneal motor, common sensory, and deep peroneal motor (DPN) fascicles from lateral to medial. Within the tunnel, the topography consolidates into the superficial peroneal motor and DPN major divisions—motor axons anteriorly and sensory axons posteriorly. Conclusions: The data presented provide clinically relevant information for the peripheral nerve surgeon where fascicular reconstruction of the nerve and neurolysis should focus on the anterior half of the nerve to restore ankle dorsiflexion. The nerve proximally is divided into 3 major fascicles compared with 2 distally. Surgeons may consider distal nerve transfers from the tibial nerve motor branches to the DPN or tibialis anterior motor branch.

Background Rupture of the extensor mechanism of the knee has severe functional morbidity, and repair can be complicated by infection, allograft degeneration, and recurrent rupture. Techniques of autologous tissue repair utilizing pedicled flaps such as the gastrocnemius offer vascularized methods of reconstruction, with potentially diminished complication rates. The goal of this study was to evaluate the functional outcomes and complications associated with pedicled flap repair of the knee extensor mechanism. Methods A systematic review was conducted following the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications that focused on local myocutaneous flaps as a means for reconstruction were included. Causes for knee extensor mechanism deficit, flap characteristics, ambulation rate, changes in range of motion pre- and postoperation, and postoperative complications were analyzed. Technique reports including primary suture repairs, synthetic mesh, and allograft use were excluded. Results An initial 119 studies were identified, with final review of 22 observational studies encompassing 128 cases of pedicled flap reconstructions. The gastrocnemius (88.2%, n = 113), quadriceps (6.3%, n = 8), and a combination of the vastus and gastrocnemius flaps (5.5%, n = 7), were the most frequently utilized flaps. Functional outcomes were favorable with 87.2% of patients achieving ambulation without external support. Variability in range of motion outcomes across different flap may be secondary to the patient characteristics as well as extent of initial injury. Conclusion Autologous pedicle flap reconstruction of the knee extensor mechanism emerges as a viable option for cases characterized by extensive defects and insufficient soft tissue coverage, which are not amenable to direct suture repairs or allografts. Postoperative assessments revealed that the majority of patients experienced improved ambulation status, with no instances of deterioration noted among the patients.

We describe a 36 -year -old man with a long-standing diagnosis of ulnar fi- brous dysplasia with associated fracture of the ulna. He presented with a growing and increasingly tender forearm mass and was diagnosed with adamantinoma of the ulna, for which he underwent wide resection of the ulnar diaphysis followed by reconstruction with a vascularized fibula au- tograft. This case serves to emphasize the importance of performing a stepwise workup for the diagnosis of osseous neoplasms even in cases with long-standing diagnoses. [Orthopedics. 2024;47(2):el02-el05.]

In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.

Background: Microsurgical breast reconstruction following mastectomy represents a high-risk patient group for venous thromboembolism (VTE), but there is limited consensus on postoperative prophylaxis duration. The aim of this study was to characterize the risk of VTE after microsurgical breast reconstruction, the risk reduction associated with postoperative outpatient VTE prophylaxis, the clinical factors associated with VTE events, and surgeon prescribing patterns regarding outpatient VTE prophylaxis. Methods: A commercially available database of 53 million unique patients, PearlDiver, was used to identify patients with breast cancer who underwent microsurgical breast reconstruction. Patients were grouped into those receiving any form of outpatient VTE prophylaxis at discharge and those who did not. Probability of VTE within 90 days was calculated for each group followed by absolute risk reduction and number needed to treat. A logistic regression, assuming binomial distribution, was performed to determine clinical factors associated with VTE events after surgery. Results: A total of 22,606 patients underwent microsurgical breast reconstruction from 2010 to 2020. Of these patients, 356 (1.6%) were discharged with VTE prophylaxis and 22,250 (98.4%) were discharged without. No patients developed a VTE in the prophylaxis group, and 403 (1.8%) developed a VTE in the group without prophylaxis. The number needed to prevent one VTE was 55.25 patients. Most VTE events occurred after postoperative day 10 (71.3%). Conclusions: Outpatient chemoprophylaxis following breast reconstruction is underused despite the majority of VTE events occurring after the acute postoperative period. Breast microsurgeons should consider routine outpatient chemoprophylaxis as part of their postoperative care pathway to optimize VTE prevention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.