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Review
. 2020 Sep 15:8:2050312120959180.
doi: 10.1177/2050312120959180. eCollection 2020.

Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

Blair R Peters  1 , Stephanie A Russo  1 , Julie M West  2 , Amy M Moore  2 , Steven A Schulz  2
Affiliations
Review

Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

Blair R Peters et al. SAGE Open Med. .

Abstract

The life altering nature of major limb amputations may be further complicated by neuroma formation in up to 60% of the estimated 2 million major limb amputees in the United States. This can be a source of pain and functional limitation of the residual limb. Pain associated with neuromas may limit prosthetic limb use, require reoperation, lead to opioid dependence, and dramatically reduce quality of life. A number of management options have been described including excision alone, excision with repair, excision with transposition, and targeted muscle reinnervation. Targeted muscle reinnervation has been shown to reduce phantom limb and neuroma pain for patients with upper and lower extremity amputations. It may be performed at the time of initial amputation to prevent pain development or secondarily for the treatment of established pain. Encouraging outcomes have been reported, and targeted muscle reinnervation is emerging as a leading surgical technique for pain prevention in patients undergoing major limb amputations and pain management in patients with pre-existing amputations.

Keywords: Neuroma; TMR; amputation; chronic pain; nerve; nerve transfer; neuroma; pain; phantom limb pain; residual limb pain; stump pain.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Intra-operative photo demonstrating the saphenous, sural, tibial, deep peroneal (DPN), and superficial peroneal (SPN) nerves in a below knee amputation prior to targeted muscle reinnervation.
Figure 2.
Figure 2.
This patient with an above knee amputation is positioned prone for secondary targeted muscle reinnervation. The sciatic nerve will be divided into the tibial and common peroneal divisions and coapted to the nerves to the semimembranosus (SM) and biceps femoris (BF), respectively.
See this image and copyright information in PMC

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