Surgical Technique for Below-knee Amputation with Concurrent Targeted Muscle Reinnervation

Area of Science:

• Plastic Surgery
• Neurosurgery
• Amputation Surgery

Background:

• Targeted muscle reinnervation (TMR) is a recognized method for reducing phantom limb pain following amputation.
• Current literature often separates the below-knee amputation (BKA) procedure from TMR, performed by different surgical teams.
• This separation can lead to suboptimal nerve preservation and increased operative time.

Purpose of the Study:

• To describe an anatomically based below-knee amputation (BKA) technique integrated with primary targeted muscle reinnervation (TMR).
• To highlight the advantages of a single-surgeon approach for performing both BKA and TMR concurrently.
• To promote the adoption of this integrated technique for improved patient outcomes.

Main Methods:

• Description of a standardized, anatomically based BKA technique performed by peripheral nerve plastic surgeons.
• Integration of TMR principles within the same surgical field as the BKA.
• Concurrent performance of BKA and TMR by a single surgeon across two institutions.

Main Results:

• The single-surgeon approach allows for efficient dissection and preservation of nerve length.
• Early identification and stimulation of recipient motor nerves are facilitated.
• Reduced tourniquet and overall operative times are achieved compared to staged procedures.

Conclusions:

• Performing BKA and TMR simultaneously by one surgeon offers significant advantages in efficiency and nerve preservation.
• This integrated technique is reliable, reproducible, and aims to increase the widespread adoption of TMR.
• The described method optimizes the surgical approach for patients undergoing BKA with planned TMR.