Targeted Muscle Reinnervation for the Treatment of Neuroma

Janes, Lindsay E.; Fracol, Megan; Dumanian, Gregory A.; Ko, Jason H.

doi:10.1016/j.hcl.2021.05.002

Cited by 20 publications

(21 citation statements)

References 38 publications

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“…Moreover, the larger space within the medulla allows for more complex and bidirectional electrodes that can be securely fastened to the cortical bone, which may allow future prosthetics with more selectivity and a higher-fidelity signal [18,33] . However, the IO with ONI approach has yet to be tested in a large animal model, and thus conclusions regarding the usefulness of this as a neural interface in humans must be guarded [36] .…”

Section: Discussionmentioning

confidence: 99%

“…IO transposition with ONI is currently in preclinical trials, with the first ONI completed involving a rabbit [36] for proof of concept and a follow-up study showing efficacy using a more complex sieve electrode [33] . Although this stable and more complex interface has shown promise, further animal studies are needed to assess the efficacy of the IO transposition with ONI in creating stable, high-fidelity interfaces.…”

Section: Intraosseous Transpositionmentioning

confidence: 99%

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Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees

Eftekari¹,

Nicksic²,

Seitz³

et al. 2022

Plast Aesthet Res

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Symptomatic neuromas are an all-too-common complication following limb amputation or extremity trauma, leading to chronic and debilitating pain for patients. Surgical resection of symptomatic neuromas has proven to be the superior method of intervention, but traditional methods of neuroma resection do not address the underlying pathophysiology leading to the formation of a future symptomatic neuroma and lead to high reoperation rates. Novel approaches employ the physiology of peripheral nerve injury to harness the regeneration of nerves to their advantage. This review explores the underlying pathophysiology of neuroma formation and centralization of pain signaling. It compares the traditional surgical approach for symptomatic neuroma resection and describes three novel surgical strategies that harness this pathophysiology of neuroma formation to their advantage. The traditional resection of symptomatic neuromas is currently the standard of care for amputation patients, but new techniques including the regenerative peripheral nerve interface, targeted muscle reinnervation, and intraosseous transposition have shown promise in improving patient pain outcomes for postamputation pain and residual limb pain. Symptomatic neuromas are a chronic and debilitating complication following amputation procedures and trauma, and the current standard of care does not address the underlying pathophysiology leading to the formation of the neuroma. New techniques are under development that may provide improved patient pain outcomes and a higher level of care for symptomatic neuroma resection.

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Section: Discussionmentioning

confidence: 99%

Section: Intraosseous Transpositionmentioning

confidence: 99%

Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees

Eftekari¹,

Nicksic²,

Seitz³

et al. 2022

Plast Aesthet Res

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“…Since its introduction into clinical practice, TMR has also proved to be an effective method for prevention and treatment of painful neuromas and phantom limb pain in adults. 9 Although literature on neuromas in pediatric amputees is sparse, children do form neuromas that sometimes necessitate surgical intervention. 10 Therefore, performing TMR at the time of amputation in children may be beneficial to prevent neuroma development and to set them up for more intuitive control of myoelectric prosthetics.…”

Section: Discussionmentioning

confidence: 99%

Targeted Muscle Reinnervation in Children: A Case Report and Brief Overview of the Literature

Pires

Moss

Ormiston

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Absence of the proximal upper limb, whether congenital or acquired, has a profound impact on quality of life. Targeted muscle reinnervation (TMR) was originally developed to improve functional control over myoelectric prostheses; however, it has also been shown to decrease phantom limb pain and neuroma pain as well as prevent neuroma formation. In children, whose rates of prosthetic use are considerably lower than adults, the effects of amputation on limb function can be devastating. To date, there is very little literature regarding the use of TMR in children. In this case report, we review the current literature and present the case of a 9-year-old boy with a transhumeral amputation secondary to a traumatic injury who underwent acute TMR at the time of wound closure. At 22 months follow-up, the patient is doing well with minimal pain, no evidence of neuroma formation, and signs of muscle reinnervation.

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“…There are some newer, very effective, surgical treatments for neuroma formation. Targeted muscle reinnervation and regenerative peripheral nerve interfaces, 72 both recently developed, are very effective ways to treat neuroma pain 73,74 . In simple terms, by connecting cut nerve ends into recently denervated muscle, new neuromuscular connections can be established; it gives axons “someplace to go and something to do” ultimately preventing painful neuroma formation.…”

Section: Electrodiagnostic Evaluation and Surgical Interventionmentioning

confidence: 99%

Traumatic injury to peripheral nerves

Robinson

2022

Muscle and Nerve

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This article reviews the epidemiology, classification, localization, prognosis, and mechanisms of recovery of traumatic peripheral nerve injuries (PNIs). Electrodiagnostic (EDx) assessments are critical components of treating patients with PNIs. In particular, motor and sensory nerve conduction studies, needle electromyography, and other electrophysiological methods are useful for localizing peripheral nerve injuries, detecting and quantifying the degree of axon loss, and contributing toward treatment decisions as well as prognostication. It is critical that EDx medical consultants are aware of the timing of these changes as well as limitations in interpretations. Mechanisms of recovery may include recovery from conduction block, muscle fiber hypertrophy, distal axonal sprouting, and axon regrowth from the site of injury. Motor recovery generally reaches a plateau at 18 to 24 months postinjury. When patients have complete or severe nerve injuries they should be referred to surgical colleagues early after injury, as outcomes are best when nerve transfers are performed within the first 3 to 6 months after onset.

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Targeted Muscle Reinnervation for the Treatment of Neuroma

Cited by 20 publications

References 38 publications

Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees

Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees

Targeted Muscle Reinnervation in Children: A Case Report and Brief Overview of the Literature

Traumatic injury to peripheral nerves

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