Targeted Muscle Reinnervation at the Time of Upper-Extremity Amputation for the Treatment of Pain Severity and Symptoms

O’Brien, Andrew; Jordan, Sumanas W.; West, Julie M.; Mioton, Lauren M.; Dumanian, Gregory A.; Valerio, Ian L.

doi:10.1016/j.jhsa.2020.08.014

Cited by 55 publications

(105 citation statements)

References 38 publications

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“…Finger amputation happen more often due to trauma (31,32,42,43). In contrast to major limb amputations where oncologic disease, diabetes and vascular disease are responsible for the majority of the indication (33)(34)(35)(36)(37)(38)41). If in major limb amputation a trauma is the cause, the trauma mechanism is more invasive and often more than the affected limb is injured (38).…”

Section: Discussionmentioning

confidence: 99%

“…Five articles reported outcomes after targeted muscle reinnervation (TMR). In this technique, a major mixed or sensory nerve is transected, the proximal end of the mixed or sensory nerve is then transferred and coapted to the distal nerve end of a transected motor nerve by end-toend neurorrhaphy, see figure 3 (36). For RLP and PLP respectively, they found 50% and 37.6% in the TMR population compared to 63.7% and 76.3% in the sample in the general amputee population.…”

Section: Targeted Muscle Reinnervationmentioning

confidence: 99%

See 1 more Smart Citation

Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review

Lange

Hundepool

Power

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Targeted Muscle Reinnervationmentioning

confidence: 99%

Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review

Lange

Hundepool

Power

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

View full text Add to dashboard Cite

show abstract

“…To date, there have been no reported cases of “telesurgery” being applied to amputation, though newer technologies may allow further investigation. For example, such studies might include a livestream video of an expert surgeon observing amputation surgery and providing “real‐time” input on approaches to soft tissue or peripheral nerve management, including targeted muscle reinnervation 2,26 . Anecdotal evidence from one of the authors (D.G.S.)…”

Section: Discussionmentioning

confidence: 99%

“…For example, such studies might include a livestream video of an expert surgeon observing amputation surgery and providing "real-time" input on approaches to soft tissue or peripheral nerve management, including targeted muscle reinnervation. 2,26 Anecdotal evidence from one of the authors (D.G.S.) suggests that this may be a common practice among surgeons and trainees, as he himself has been remotely called into the operating room.…”

Section: Surgical Decision Making and Inpatient Care Phasementioning

confidence: 99%

COVID‐19: A catalyst for change in virtual health care utilization for persons with limb loss

Hewitt

Smith

Heckman

et al. 2021

PM&R

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The dramatic uptake of virtual care, or telehealth, utilization because of COVID-19 restrictions for persons with limb loss has led to a much greater understanding of this health care delivery method for this complex patient population. However, much is still unknown. Therefore, the authors provide a comprehensive literature review of existing evidence for virtual care delivery across the phases of amputation rehabilitation, as well as anecdotal evidence, to provide a platform for further discussion and development of research and innovative opportunities. Evidence reveals that virtual care serves as a complement to in-person health care for individuals with limb loss because it allows for increased accessibility to these services. The authors conclude that continued use of telehealth beyond the COVID-19 restrictions to optimize outcomes across the continuum of care for persons with limb loss is warranted.

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“…TMR is not limited to secondary intervention and can also be performed preemptively at the time of amputation. Studies assessing TMR as a primary intervention have demonstrated reduced phantom limb pain, improved outcomes related to pain quality, and lower rates of opioid use (Valerio et al, 2020 ; O'Brien et al, 2021 ). Similarly, a study of primary TMR in below knee amputations (BKA) did not find that any patients developed symptomatic neuromas during the follow up period.…”

Section: Surgical Techniquesmentioning

confidence: 99%

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

2021

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Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided “silos,” we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.

show abstract

Targeted Muscle Reinnervation at the Time of Upper-Extremity Amputation for the Treatment of Pain Severity and Symptoms

Cited by 55 publications

References 38 publications

Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review

Prevention is better than cure: Surgical methods for neuropathic pain prevention following amputation – A systematic review

COVID‐19: A catalyst for change in virtual health care utilization for persons with limb loss

The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements

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