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Demystifying Targeted Muscle Reinnervation: A Simplified Approach to Optimal Amputation Management
Joshua T. Henderson, MD
Zachary A. Koenig, BS
Mihail Climov, MD
Jack Gelman, MD
West Virginia University
2022-01-14
Presenter: Joshua T. Henderson, MD
Affidavit:
To whom It may concern:
This research has not been published elsewhere not presented at a major meeting.
Kerri Woodberry, MD, MBA, FACS
Director Name: Kerri M Woodberry
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Despite inspiring improvements in post-amputation pain and prosthetic control, targeted muscle reinnervation (TMR) continues to be under-utilized. The opportunity to enhance amputation and neuroma care is not universally realized. Additionally, there is a paucity of data and anatomical descriptions in the settings of different amputation sites. This holistic review discusses the coaptations reported in the literature to date.
A literature review was performed to collect all original reports describing nerve transfers at each amputation level. The preference was directed towards the articles with surgical techniques and coaptations utilized in TMR. Our institution experience was systematized and incorporated into the analysis.
A total of 507 articles were collected in the literature search. Abstract review identified 195 discussing TMR. Thirty-two original studies describing TMR nerve transfers at various amputation levels were identified after meeting inclusion criteria. Numerous transfers have been successfully performed at all levels, but specific recipient motor branches are favored in each region. A comprehensive list of all transfers performed for all peripheral nerves at each amputation level were included in tables specific to anatomic region. The improvement in pain is consistent among recipient muscles, but more superficial options are favorable for greater cutaneous electrode detection for powering myoelectric prostheses.
TMR is a novel surgical technique that has revolutionized management of amputation-related pain and myoelectric prostheses. It should be considered by all surgeons performing an amputation, given these benefits. The technique is becoming routine at multiple amputation sites, and numerous coaptations for each level have been reported in the literature.
