American Society for Peripheral Nerve

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Targeted Muscle Reinnervation for Surgical Pain Management in Amputees: Clinical Case Series at a Single Academic Medical Institution
Brendan J MacKay, MD; Joash R Suryavanshi, BA; Bradley Osemwengie, BA; Nancy E Swinford, R.T. (R)(ARRT), CCRC; Desirae McKee, MD
Texas Tech University Health Science Center, Lubbock, TX

The incidence of limb amputation in the United States is on the rise. The function and well-being of amputees can be comprised by chronic localized pain due to symptomatic neuromas in the residual limb, phantom pain, and issues with prosthetic use. Targeted muscle reinnervation (TMR) is a novel surgical procedure that transfers residual nerves from amputated limbs to new muscle targets via muscular nerve branches. TMR has been shown to significantly reduce neuroma and phantom pain. In addition, it can facilitate the use of sophisticated prostheses. Most of the established literature has been presented in animal studies, military populations, or at the institution where TMR was first developed. In this study, we present preliminary data on a TMR case series at an academic hospital serving the general population in a large catchment area.

Materials and Methods:
Retrospective review of acute and chronic amputee patients who underwent TMR at our institution was completed. All procedures were done by fellowship trained hand surgeons. Post-operative follow-up data was collected at the 6 weeks, 3 months, and 6 months. Specifically, phantom pain, stump pain, and use of narcotic pain medication was evaluated. Pain was patient reported on a 10 point Likert scale. Complications of TMR and/or revision surgeries were cataloged.

Ten patients who underwent TMR were identified. 9 patients (90%) were male and the average age of study subjects was 39.5 years (range: 19-67). Six patient (60%) had left-sided amputations and 4 patients (40%) had right sided amputations; 5 amputations (50%) were upper extremity and 5 amputations (50%) were lower extremity. Nine amputations (90%) were caused by acute or traumatic injury to the extremity and only 1 amputation (10%) was indicated for a chronic disease. At 6-week follow up, average phantom pain was 4 out of 10 (range: 2-5) and the average stump pain rating was 2 out of 10 (range: 2-3). Use of narcotic pain medication was ceased in all patients by their 6-month follow up appointment. There were no complications or revisions. Additional follow-up is on-going.

All patients in this case series show significant improvement in neuropathic pain symptoms after TMR, as compared with historical controls. Need for long-term narcotic pain medication use was eliminated. This study further supports TMR as an important adjunct in the treatment of limb amputees.

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