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Recurrent Neuroma At the Site of Targeted Muscle Reinnervation: A Case Report
Corinne Wee MD, David Kurlander MD, Katherine Grunzweig MD, B. Todd Bafus MD, Kyle Chepla MD
Case Western Reserve University Department of Plastic Surgery
2021-02-12
Presenter: Corinne Wee
Affidavit:
The entire abstract represents the original work of the resident and other authors involved.
Director Name: Edward Davidson MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Targeted Muscle Reinnervation (TMR), originally designed to improve prosthetic control, has been shown to decrease phantom limb pain (PLP) and residual limb pain (RLP) associated with amputation. Despite its encouraging outcomes, there is a lack of literature describing potential complications. The purpose of this case report is to describe a unique complication following TMR.
Methods: This is a case report of a patient who presented to our multidisciplinary amputee clinic. Data was collected via retrospective chart review of VAS scores for RLP and PLP pain, as well as range of motion scores recorded by his occupational therapist.
Results: This is a 36-year-old male who underwent TMR of his median nerve to the AIN motor branch to the pronator quadratus. Four months postoperatively, the patient presented with increasing PLP and RLP pain as well as an inability to supinate his residual forearm past 20 degrees. An MRI demonstrated recurrent neuroma at the site of TMR which was confirmed at surgery. The terminal neuroma was excised, and the distal end of the median nerve was wrapped in a muscle cuff to create a regenerative peripheral nerve interface (RPNI). Following the procedure, the patient had an immediate improvement of supination to 55 degrees and an 80% decrease in RLP and PLP by four months postoperatively.
Conclusion: While TMR has demonstrated promising outcomes, recurrent symptomatic neuromas at the site of transfer site are a potential complication. Peripheral nerve surgeons should consider this diagnosis in the setting of increasing PLP and RLP following TMR.
