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Necrotizing Fasciitis and Targeted Muscle Reinnervation in the Upper Extremity: A Case Report.

Joaquín Herrera Leigh1,2, Carlos A Córdova1,2, Sara Fischer1,2

  • 1Department of Traumatology and Orthopaedic, Hospital del Trabajador, Santiago, Chile.

The American Journal of Case Reports
|October 3, 2025
PubMed
Summary

Necrotizing fasciitis (NF) of the upper limb is rare but life-threatening. Targeted muscle reinnervation (TMR) successfully treated neuroma pain after a transhumeral amputation for NF, improving patient outcomes.

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Area of Science:

  • Infectious Diseases
  • Surgical Innovation
  • Reconstructive Surgery

Background:

  • Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection with high mortality.
  • Upper limb NF is rare, with proximal major amputations like transhumeral amputation being exceedingly uncommon.
  • Targeted muscle reinnervation (TMR) offers a novel approach to enhance postoperative results and pain management.

Purpose of the Study:

  • To report a rare case of upper limb necrotizing fasciitis requiring transhumeral amputation.
  • To detail the successful application of Targeted Muscle Reinnervation (TMR) for managing postoperative neuroma-related pain.
  • To highlight the diagnostic utility of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and the importance of early surgical intervention.

Main Methods:

  • A case report of a 48-year-old male with a wrist crush injury who developed necrotizing fasciitis.
  • Initial management included broad-spectrum antibiotics, ICU support, and emergency transhumeral amputation.
  • Postoperative neuroma-related pain was treated with Targeted Muscle Reinnervation (TMR).

Main Results:

  • The patient developed septic shock and multi-organ failure, necessitating emergency transhumeral amputation.
  • Following amputation and debridements, the patient stabilized but experienced persistent neuroma-related pain.
  • Targeted Muscle Reinnervation (TMR) effectively resolved the patient's pain symptoms.

Conclusions:

  • Upper limb NF is a critical condition demanding rapid diagnosis and aggressive treatment.
  • The LRINEC score aids in diagnosing NF, and prompt surgery is crucial.
  • Targeted Muscle Reinnervation (TMR) presents a promising solution for pain reduction and functional improvement in upper limb amputees.