“Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation”

Abstract

Background: Targeted muscle reinnervation (TMR) is an effective technique for the prevention and management of phantom limb pain (PLP) and residual limb pain (RLP) among amputees. The purpose of this study was to evaluate symptomatic neuroma recurrence and neuropathic pain outcomes between cohorts undergoing TMR at the time of amputation (ie, acute) versus TMR following symptomatic neuroma formation (ie, delayed). Methods: A cross-sectional, retrospective chart review was conducted using patients undergoing TMR between 2015 and 2020. Symptomatic neuroma recurrence and surgical complications were collected. A subanalysis was conducted for patients who completed Patient-Reported Outcome Measurement Information System (PROMIS) pain intensity, interference, and behavior scales and an 11-point numeric rating scale (NRS) form. Results: A total of 105 limbs from 103 patients were identified, with 73 acute TMR limbs and 32 delayed TMR limbs. Nineteen percent of the delayed TMR group had symptomatic neuromas recur in the distribution of original TMR compared with 1% of the acute TMR group (P < 0.05). Pain surveys were completed at final follow-up by 85% of patients in the acute TMR group and 69% of patients in the delayed TMR group. Of this subanalysis, acute TMR patients reported significantly lower PLP PROMIS pain interference (P < 0.05), RLP PROMIS pain intensity (P < 0.05), and RLP PROMIS pain interference (P < 0.05) scores in comparison to the delayed group. Conclusions: Patients who underwent acute TMR reported improved pain scores and a decreased rate of neuroma formation compared with TMR performed in a delayed fashion. These results highlight the promising role of TMR in the prevention of neuropathic pain and neuroma formation at the time of amputation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review

“…54 This procedure has also been associated with a lower incidence of both symptomatic neuromas and phantom limb pain compared to controls. 55 Traditional nerve management techniques prior to TMR and RPNI development included traction neurectomy, suture ligation of free nerve ends, and burial of free nerve ends into muscle…”

Discussion: Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation

“…A my Moore's peripheral nerve surgery group at The Ohio State University describes their experience using targeted muscle reinnervation (TMR) at the time of an amputation to prevent residual limb pain (RLP) from painful neuromas and phantom limb pain (PLP). 1 This "preemptive" use of TMR (early TMR) is compared with using TMR to treat existing painful neuromas in patients who previously had a limb amputation (late TMR). They concluded that both early and late TMR are effective in relieving RLP and PLP, with early TMR being significantly more effective.…”