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Abstract

Medicine

Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Published: March 8th, 2024

DOI:

10.3791/66379

1Center for Bionics and Pain Research, 2Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, 3Department of Electrical Engineering, Chalmers University of Technology, 4Bionics Institute, 5IV Clinica Ortoplastica, IRCCS Istituto Ortopedico Rizzoli, 6Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 7Department of Orthopedic, Hand Unit, Worker Hospital, 8College of Medicine and Veterinary Medicine, The Queen's Medical Research Institute, The University of Edinburgh, 9Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 10College of Medicine, Veterinary & Life Sciences, The University of Glasgow, 11Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 12Plastics and Reconstructive Surgery, Dandenong Hospital, Monash Health, 13Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital &, Harvard Medical School, 14Section of Plastic Surgery, Department of Surgery, Michigan Medicine, 15Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 16Department of Plastic and Reconstructive Surgery, Ohio State University, 17Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, 18Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, 19Medical Bionics Department, University of Melbourne, 20Prometei Pain Rehabilitation Center

Abstract

Over the past decade, the field of prosthetics has witnessed significant progress, particularly in the development of surgical techniques to enhance the functionality of prosthetic limbs. Notably, novel surgical interventions have had an additional positive outcome, as individuals with amputations have reported neuropathic pain relief after undergoing such procedures. Subsequently, surgical techniques have gained increased prominence in the treatment of postamputation pain, including one such surgical advancement - targeted muscle reinnervation (TMR). TMR involves a surgical approach that reroutes severed nerves as a type of nerve transfer to "target" motor nerves and their accompanying motor end plates within nearby muscles. This technique originally aimed to create new myoelectric sites for amplified electromyography (EMG) signals to enhance prosthetic intuitive control. Subsequent work showed that TMR also could prevent the formation of painful neuromas as well as reduce postamputation neuropathic pain (e.g., Residual and Phantom Limb Pain). Indeed, multiple studies have demonstrated TMR's effectiveness in mitigating postamputation pain as well as improving prosthetic functional outcomes. However, technical variations in the procedure have been identified as it is adopted by clinics worldwide. The purpose of this article is to provide a detailed step-by-step description of the TMR procedure, serving as the foundation for an international, randomized controlled trial (ClinicalTrials.gov, NCT05009394), including nine clinics in seven countries. In this trial, TMR and two other surgical techniques for managing postamputation pain will be evaluated.

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Keywords Targeted Muscle Reinnervation

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