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Targeted muscle reinnervation for treatment of symptomatic neuroma after digital or partial hand amputation: a cadaveric feasibility study
Kyle J Chepla
Yuewei Wu-Fienberg
Case Western Reserve University
2019-01-27
Presenter: Yuewei Wu-Fienberg
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Anand Kumar
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Targeted muscle reinnervation (TMR) has been utilized after shoulder disarticulation, transhumeral and transradial level amputations. While first done for improved prosthetic control, recent studies have also demonstrated a statistically significant reduction in phantom limb pain and a reduction in residual limb neuroma pain. We performed a cadaver dissection to assess whether this technique could be applied to symptomatic neuromas after digital or partial hand amputation.
Methods: The median and ulnar nerves of a fresh cadaver hand were dissected from proximal to distal utilizing an extended carpal tunnel-type incision under 4.5x loupe magnification. All sensory and motor branches were successfully identified and dissected. Simulated transfers of digital nerves to lumbrical motor branches, common digital nerves to lumbrical motor branches or the recurrent motor branch, and the common sensory portion of the ulnar nerve to a hypothenar motor branch were performed.
Results: Dissection of the motor nerve branches to the intrinsic muscles of the hand is possible under loupe magnification. The proximity of all sensory nerves to motor branches and the numerous redundant motor nerve targets available support our hypothesis that TMR is possible for treatment of symptomatic digital neuromas and neuromas from partial hand amputation.
Conclusions: We have demonstrated that targeted muscle reinnervation for the treatment, or prevention, of symptomatic neuromas after digital or partial hand amputation is anatomically and surgical feasible. Further studies will be required to evaluate clinical indications and outcomes.
