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Targeted Muscle Reinnervation in the Challenging Patient
Terri A. Zomerlei MD
Ian L Valerio MD, MS, MBA
The Ohio State University
2016-02-01
Presenter: Terri A Zomerlei
Affidavit:
Gregory Pearson MD
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Targeted Muscle Reinnervation (TMR) is a surgical technique that was initially developed as a method in which to provide intuitive control of an upper limb prosthesis by employing novel nerve transfers. The nerve transfers are performed at the time of amputation using microsurgical technique and can be performed on any level amputation of the upper or lower extremity. This reinnervation technique is not only beneficial for those undergoing limb amputation for treatment of neoplasms, but also for those needing amputation related to trauma or failed limb salvage. A frequently cited benefit of this technique is the prevention of painful neuroma formation. Our group has been performing and studying the application of this surgical treatment to other patient populations with early good results and success, thus expanding its application beyond the established traumatic amputee patient population in which TMR has been traditionally described.
Methods
A series of patient cases with unique medical comorbidities and circumstances that received TMR were reviewed. Details regarding surgical technique, post-operative management and subsequent patient follow-up were noted.
Results
All patients with unique co-morbidities underwent successful TMR without post-operative complications. In 3- 6 month follow-up, all patients reported either resolution of neuroma symptoms or failure to develop painful neuromas, thus improving their quality of life and ability to interact with a prosthesis if desired.
Conclusion
TMR is a powerful technique that can treat and prevent neuromas and other adverse neurologic sequelae even in challenging patient populations.
