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Management of Superficial and Deep Peroneal Neuromas with Targeted Muscle Reinnervation in Non-Amputees
Simon Moradian, MD1, Sripadh Sharma, BS PhD2, Iulianna Taritsa, BA2, Lauren M Mioton, M.D.3, Jason H Ko, MD, MBA, FACS4 and Gregory A Dumanian, M.D.5, (1)Northwestern Memorial, Chicago, IL, (2)Northwestern Memorial Hospital, Chicago, IL, (3)Northwestern University, Chicago, IL, (4)Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, (5)Northwestern University Feinberg School of Medicine, Chicago, IL

Introduction: Neuroma pain is associated with a significant impact on patients' quality of life. Targeted muscle reinnervation (TMR) is a surgical technique developed by the senior author that has demonstrated efficacy in the treatment and prevention of neuroma pain in both amputee and non-amputee patients. The objective of this study was to describe the surgical technique for TMR of the superficial peroneal nerve (SPN) and deep peroneal nerve (DPN) in non-amputee patients while prospectively evaluating pain scores via a novel cellphone-based app platform.
Methods: Between March 2018 and April 2021, 19 patients underwent TMR of the SPN and/or DPN at our institution. All patients were non-amputees who suffered from moderate-to-severe pain in the peroneal nerve distribution or described neuroma-like pain at the site of a prior surgical incision or traumatic injury. Operative and perioperative outpatient notes were reviewed. The anatomy of the peroneal nerve and detailed operative techniques for SPN/DPN TMR were then reviewed. Additionally, patients are currently being enrolled into the Zing PainApp platform for further biophysical assessment of pain and function.
Results: Of the 19 patients reviewed, 11 patients underwent TMR of the SPN alone: 8 had complete resolution of their symptoms; 2 indicated a partial improvement in pain; and 1 patient had no improvement upon follow up at 6 months. Four patients underwent TMR of the DPN alone: 2 patients had complete resolution of their pain, and 2 patients had partial improvement with pain. Finally, 4 patients underwent TMR of both the SPN/DPN: 2 patients had complete resolution of their pain and symptoms, and 2 patients were noted to have significant improvement; however, they continued to have persistent dorsal foot pain and a detectable Tinel's sign in areas of incisions from prior foot surgeries.
Discussion: Targeted muscle reinnervation has emerged as a successful technique for the management of neuroma pain in both amputees and non-amputees. In this study, we have outlined the anatomy of the superficial and deep peroneal nerve and described the surgical technique for TMR of the SPN and DPN in non-amputee patients. Our technique revealed excellent clinical outcomes, no procedure-specific complications, improved subjective pain reports with further data being prospectively collected via a novel cellphone-based pain application.


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