Summary:
Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following below-knee amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.
Summary:Targeted muscle reinnervation (TMR) has been shown to decrease neuroma pain after major limb loss; however, it has not previously been described for the treatment of symptomatic neuromas in the hand after digit amputations. This report describes the use of TMR in the hand for treatment of a patient with recurrent neuromas after ray amputation of the index and long fingers that were refractory to traditional treatments. TMR was performed first for the superficial branch of the radial nerve 6 years ago to treat the dorsal neuroma pain. Following this, there was complete resolution on the dorsal aspect of the hand, however, continued neuroma pain on the volar aspect of the hand. This was treated more recently with excision of the neuromas and TMR to motor branches of the intrinsic muscles of the hand. Outcomes were measured with a numerical rating scale and Patient-Reported Outcomes Measurement System assessments and revealed decreased pain postoperatively and less interference of her activities due to pain. This report demonstrates the ability to perform TMR within the hand with good results when used for the treatment of symptomatic neuromas.
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