Reduction of Phantom Limb Pain and Improved Proprioception through a TSR-Based Surgical Technique: A Case Series of Four Patients with Lower Limb Amputation

Abstract

Four patients underwent targeted sensory reinnervation (TSR), a surgical technique in which a defined skin area is first selectively denervated and then surgically reinnervated by another sensory nerve. In our case, either the area of the lateral femoral cutaneous nerve or the saphenous nerve was reinnervated by the sural nerve. Patients were then fitted with a special prosthetic device capable of transferring the sense of pressure from the sole of the prosthesis to the newly wired skin area. Pain reduction after TSR was highly significant in all patients. In three patients, permanent pain medication could even be discontinued, in one patient the pain medication has been significantly reduced. Two of the four patients were completely pain-free after the surgical intervention. Surgical rewiring of existing sensory nerves by TSR can provide the brain with new afferent signals seeming to originate from the missing limb. These signals help to reduce phantom limb pain and to restore a more normal body image. In combination with special prosthetic devices, the amputee can be provided with sensory feedback from the prosthesis, thus improving gait and balance.

„Targeted muscle reinnervation“ und „targeted sensory reinnervation“

“…Eine aktuelle Studie [14] berichtet über 4 Patienten, beideneninnerhalb eines Zeitraums von 5,5 Jahren rein sensible Nerventransfers vorgenommen wurden. Der Stumpf des N. suralis wurde in einem Fall auf den Endast des N. saphenus und in einem weiteren auf den N. cutaneus femoris lateralis koaptiert.…”

Treating phantom limb pain: cryoablation of the posterior tibial nerve

“…The peripheral nervous system also appears to play a role in phantom limb pain [13] . Amputees frequently develop neuromas, abnormal bundles of nerve tissue, at the site of amputation which can be seen in 13%-32% of patients.…”

Effectiveness of graded motor imagery protocol in phantom limb pain in amputed patient: Protocol of a randomized clinical trial

“…A study in 2005 reported that 60–80% of amputees suffer from PLP [ 2 ], and in a subsequent study in 2020 this was reported as 67–87% of amputees [ 3 ], although not with the same intensity or frequency of symptoms [ 4 ]. PLP after amputation occurs due to multifactorial mechanisms [ 5 ]. There are various predictive factors that influence the perception of pain, such as pre-amputation pain, location, sex and time of evolution, among others [ 5 ].…”

“…PLP after amputation occurs due to multifactorial mechanisms [ 5 ]. There are various predictive factors that influence the perception of pain, such as pre-amputation pain, location, sex and time of evolution, among others [ 5 ]. In 72% of cases, it appears in the week following the amputation [ 6 ].…”

“…More than two dozen techniques can be found in the literature for the management of PLP [ 5 ]. However, there is no broad consensus on the best and most effective option [ 1 ].…”