Pain and Functional Outcomes Following Targeted Muscle Re-innervation: A Systematic Review

Abstract

Background: It is estimated that by 2050, a total of 3.6 million patients will be living with an amputation in the United States. The objective of this systematic review is to evaluate the effect of targeted muscle reinnervation (TMR) on pain and physical functioning in amputees. Methods: A literature search was performed on PubMed, Embase, and MEDLINE up to November 28, 2021. Clinical studies assessing the outcomes of TMR (pain, prosthesis control, life quality, limb function, and disability) were included. Results: Thirty-nine articles were included. The total number of patients who underwent TMR was 449, and 716 were controls. Mean follow-up was 25 months. A total of 309 (66%) lower-limb and 159 (34%) upper-limb amputations took place in the TMR group, the most common being below-knee amputations (39%). The control group included a total of 557 (84%) lower-limb and 108 (16%) upper-limb amputations; the greatest proportion being below-knee amputations in this group as well (54%). Trauma was the most common indication for amputation. Phantom limb pain scores were lower by 10.2 points for intensity (P = 0.01), 4.67 points for behavior (P = 0.01), and 8.9 points for interference (P = 0.09). Similarly, residual limb pain measures were lower for cases for intensity, behavior, and interference, but they failed to reach significance. Neuroma symptoms occurred less frequently, and functional and prosthesis control outcomes improved following TMR. Conclusion: The literature evidence suggests that TMR is a promising therapy for improving pain, prosthesis use, and functional outcomes after limb amputation.

Emerging Value of Osseointegration for Intuitive Prosthetic Control after Transhumeral Amputations: A Systematic Review

“…This can be achieved by myoneural signal amplification in surgical procedures such as targeted muscle reinnervation or regenerative peripheral nerve interface. [33][34][35][36][37] These approaches allow for hyperreinnervation of a target muscle and muscle tissue via surgical nerve rewiring, resulting in amplification of myoelectrical signals from the reinnervated muscles that can be decoded using electromyography (EMG) signal capture software and hardware for bioprosthetic function. [38][39][40] With the rise of implantable EMG electrodes, there is a need for reliable signal transmission to enhance bioprosthetic function.…”

Pethidine dependence syndrome in a patient with stump pain

“…Zwraca się również uwagę na działania prewencyjne w zakresie wystąpienia bólu kikuta o charakterze neuropatycznym poprzez zastosowanie odpowiedniej techniki chirurgicznej podczas zabiegu amputacji, takiej jak celowana reinerwacja mięśni (ang. targeted muscle reinnervation -TMR) [24], celowana implantacja nerwów, koaptacja nerwów czy regeneracyjny interfejs nerwów obwodowych (ang. regenerative peripheral nerve interface -RPNI) [25][26][27].…”

Discussion: Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic Review

“…W e commend ElAbd et al on publishing their article, "Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic Review," in this issue of Plastic and Reconstructive Surgery. 1 This systematic review, including data from 39 studies on 1165 patients, demonstrates that the literature supports targeted muscle reinnervation (TMR) as a technique to decrease neuropathic pain following major limb amputations. These data are validating for those of us who have been independently performing these operations, with successful and promising outcomes.…”