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Author Spotlight: Advancements and Challenges in Surgical Treatments for Postamputation Pain
Published on: March 8, 2024
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Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation
Evelyn G Goodyear1, Andrew L O'Brien1, Julie M West1
1From the Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center.
Plastic and Reconstructive Surgery
|May 18, 2023
Summary
Acute targeted muscle reinnervation (TMR) significantly reduces neuroma recurrence and phantom limb pain (PLP) compared to delayed TMR. Performing TMR during amputation offers better outcomes for amputees.
Area of Science:
- Reconstructive surgery
- Pain management
- Amputee care
Background:
- Targeted muscle reinnervation (TMR) is a key technique for managing phantom limb pain (PLP) and residual limb pain (RLP) in amputees.
- Neuroma formation and recurrence are significant complications following amputation.
Purpose of the Study:
- To compare outcomes of acute TMR (at time of amputation) versus delayed TMR (after neuroma formation).
- To evaluate symptomatic neuroma recurrence and neuropathic pain in both TMR cohorts.
Main Methods:
- Retrospective chart review of 103 patients (105 limbs) undergoing TMR between 2015-2020.
- Data collected included symptomatic neuroma recurrence, surgical complications, and patient-reported outcomes (PROMIS scales, NRS).
Main Results:
- Acute TMR (73 limbs) showed significantly lower neuroma recurrence (1%) versus delayed TMR (19%) (P < 0.05).
- Acute TMR patients reported lower PLP and RLP PROMIS pain interference and intensity scores compared to the delayed group.
Conclusions:
- Acute TMR demonstrates superior outcomes in reducing neuroma formation and improving pain scores compared to delayed TMR.
- TMR at the time of amputation is a promising strategy for preventing neuropathic pain and neuroma complications.
