Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

A 55-year-old male, smoker, with no other comorbidities, was referred to our hospital with signs and symptoms of acute left lower limb ischemia, which was not salvageable. He underwent an Above Knee Amputation [AKA] to avoid sepsis and relieve pain. He was discharged on therapeutic dose of Rivaroxaban as he had a past history of unprovoked venous thromboembolism. Post AKA, his stump wound was healthy. Two weeks post-op he reported to the emergency with history of swelling and pain on the stump edge. Upon examination, there was 2 by 2 cm collection on the lateral edge of his stump wound. Under local anesthesia, the collection was drained. This was thought to be an infected hematoma. He started regular physiotherapy once the incision site healed.

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“…Up to 60% of patients with a nerve injury can develop a painful neuroma [4]. The diagnosis of a neuroma relies on history and examination.…”

Section: Discussionmentioning

confidence: 99%

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Hala¹,

Stephen²,

Sameer³

et al. 2022

J Clin Images Med Case Rep

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“…The most successful wireless design thus far is the IMES system, which uses implantable sensors within the residual limb for prosthetic control (Weir et al, 2009). It is currently being used in clinical trials and has demonstrated effective and reliable signaling in TMR patients (Merrill et al, 2011;Pasquina et al, 2015). Other potential designs explore the use of magnetic beads (Herr et al, 2020) and implantable capsules.…”

Section: Fully Implantable Systemmentioning

confidence: 99%

“…Neuroma treatment and prevention with TMR has been used in both upper and lower extremity amputations. In terms of prosthetic control, TMR has only been used in individuals with upper extremity amputations (Oh and Carlsen, 2019 ; Peters et al, 2020 ). However, anatomic studies have identified transfer patterns and potential motor targets in BKAs (Fracol et al, 2018 ) and transfemoral amputations (TFA) (Agnew et al, 2012 ).…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…The substantial progress that has been made in the field of neuroprosthetics and the formation of silos is reflected in the robust body of literature published on these topics. Many of the reviews focus on a specific area of the field such as electrodes (Rijnbeek et al, 2018 ; Russell et al, 2019 ; Raspopovic et al, 2020 ); interface design (Larson and Meng, 2020 ), or surgical techniques like Targeted Muscle Reinnervation (TMR) (Mioton and Dumanian, 2018 ; Oh and Carlsen, 2019 ; Peters et al, 2020 ); and Regenerative Peripheral Nerve Interface (RPNI) (Santosa et al, 2020 ). Others explore algorithmic control systems (Wolf et al, 2020 ); prosthetic device designs (Naufel et al, 2020 ); and specific outcomes such as sensation or myoelectric control (Tyler, 2015 ; Geethanjali, 2016 ; Ghafoor et al, 2017 ; Sensinger and Dosen, 2020 ; Raspopovic et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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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.

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“…Peripheral nerve injury causes a loss of sensory and motor function, and has a significant impact on the quality of life ( 1 ). In the United States alone, >200,000 nerve repair treatments are performed each year ( 2 ). For short lengths of nerve damage, the conventional clinical procedure, end-to-end anastomosis, is appropriate ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Pericyte‑derived extracellular vesicles‑mimetic nanovesicles improves peripheral nerve regeneration in mouse models of sciatic nerve transection

et al. 2021

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Pericyte-derived extracellular vesicle-mimetic nanovesicles (PC-NVs) play an important role in the improvement of erectile function after cavernous nerve injury. However, the impact of PC-NVs on the peripheral nervous system (PNS), such as the sciatic nerve, is unclear. In this study, PC-NVs were isolated from mouse cavernous pericytes (MCPs). A sciatic nerve transection (SNT) model was established using 8-week-old C57BL/6J mice. The sciatic nerve was harvested 5 and 14 days for immunofluorescence and western blot studies. Function studies were evaluated by performing the rotarod test and walking track analysis. The results demonstrated that PC-NVs could stimulate endothelial cells, increase neuronal cell content, and increase macrophage and Schwann cell presence at the proximal stump rather than the distal stump in the SNT model, thereby improving angiogenesis and nerve regeneration in the early stage of sciatic nerve regeneration. In addition, PC-NVs also increased the expression of neurotrophic factors (brain-derived nerve growth factor, neurotrophin-3 and nerve growth factor) and the activity of the cell survival signaling pathway (PI3K/Akt signaling), and reduced the activity of the JNK signaling pathway. Additionally, after 8 weeks of local application of PC-NVs in SNT model mice, their motor and sensory functions were significantly improved, as assessed by performing the rotarod test and walking track analysis. In conclusion, the present study showed that the significant improvement of neurovascular regeneration in mice following treatment with PC-NVs may provide a favorable strategy for promoting motor and sensory regeneration and functional recovery of the PNS.

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Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

Cited by 31 publications

References 36 publications

Is that a berry?

Is that a berry?

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

Pericyte‑derived extracellular vesicles‑mimetic nanovesicles improves peripheral nerve regeneration in mouse models of sciatic nerve transection

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