Targeted Muscle Reinnervation Technique in Below-Knee Amputation.

Area of Science:

• Regenerative medicine
• Neurosurgery
• Pain management

Background:

• Chronic pain, including symptomatic neuromas and phantom limb pain, affects approximately 25% of major limb amputees.
• Targeted reinnervation (TR) has shown success in treating peripheral neuropathy and phantom limb pain in upper limb amputees.
• A surgical description for TR in below-knee amputations is currently lacking in medical literature.

Purpose of the Study:

• To describe the clinical indications and surgical technique for targeted muscle reinnervation (TMR) in below-knee amputations.
• To evaluate the efficacy of TMR in resolving neuroma and phantom limb pain in this patient population.
• To assess patient satisfaction and functional outcomes following TMR for below-knee amputation.

Main Methods:

• A cohort of 22 patients undergoing below-knee amputation received TMR.
• Patients were followed for one year post-surgery to assess pain symptoms, satisfaction, and functionality.
• Clinical indications and the detailed surgical technique for TMR in below-knee amputation were documented.

Main Results:

• All patients denied neuroma pain post-amputation.
• While most patients initially reported phantom limb pain at 1 month, all experienced complete resolution by 3 months.
• The study demonstrates successful application of TMR in below-knee amputations, aligning with previous findings at other amputation levels.

Conclusions:

• Targeted muscle reinnervation is an effective treatment for preventing and resolving neuroma and phantom limb pain in below-knee amputees.
• This technique offers a viable solution for pain management and improved function in the residual limb.
• The described surgical approach fills a gap in the literature for TMR in below-knee amputations.