Targeted Muscle Reinnervation—an Up-to-Date Review: Evidence, Indications, and Technique

Abstract

Targeted muscle reinnervation (TMR) is a surgical technique originally created to improve prosthetic function following upper extremity amputation. TMR has since been shown to be effective in the prevention and treatment of chronic postamputation phantom and residual limb pain in both upper and lower extremity amputees and for neurogenic pain in the nonamputee patient population. This article provides a current review of the various indications for TMR and surgical techniques, organized by amputation site, timing, and regional anatomy.

Keywords

targeted muscle reinnervation - nerve transfers - painful neuromas - myoelectric prosthesis

Ethical Approval

This work did not require IRB approval.

Patient Consent

Written informed consents were obtained for all of the clinical images and videos used for this manuscript.

Authors' Contributions

All authors—A.G.C., M.D.R., S.P., G.A.D., and J.H.K.—contributed to the creation of the manuscript and met the criteria for authorship.

Specific roles are mentioned below.

Conceptualization, writing—review and editing: all authors.

Writing—original draft: A.G.C., M.D.R., S.P., and G.A.D.

Supervision: J.H.K.

Publication History

Received: 23 May 2023

Accepted: 21 April 2024

Article published online:
01 April 2025

• References

• 1 Dumanian GA, Potter BK, Mioton LM. et al. Targeted muscle reinnervation treats neuroma and phantom pain in major limb amputees: a randomized clinical trial. Ann Surg 2019; 270 (02) 238-246
• 2 Kuiken TA, Dumanian GA, Lipschutz RD, Miller LA, Stubblefield KA. The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee. Prosthet Orthot Int 2004; 28 (03) 245-253
• 3 Kuiken TA, Miller LA, Lipschutz RD. et al. Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study. Lancet 2007; 369 (9559) 371-380
• 4 Hijjawi JB, Kuiken TA, Lipschutz RD, Miller LA, Stubblefield KA, Dumanian GA. Improved myoelectric prosthesis control accomplished using multiple nerve transfers. Plast Reconstr Surg 2006; 118 (07) 1573-1578
• 5 Gilron I, Bailey JM, Tu D, Holden RR, Weaver DF, Houlden RL. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352 (13) 1324-1334
• 6 Agnew SP, Ko J, De La Garza M, Kuiken T, Dumanian G. Limb transplantation and targeted reinnervation: a practical comparison. J Reconstr Microsurg 2012; 28 (01) 63-68
• 7 Chappell AG, Jordan SW, Dumanian GA. Targeted muscle reinnervation for treatment of neuropathic pain. Clin Plast Surg 2020; 47 (02) 285-293
• 8 Johnson CC, Loeffler BJ, Gaston RG. Targeted muscle reinnervation: a paradigm shift for neuroma management and improved prosthesis control in major limb amputees. J Am Acad Orthop Surg 2021; 29 (07) 288-296
• 9 Cheesborough JE, Smith LH, Kuiken TA, Dumanian GA. Targeted muscle reinnervation and advanced prosthetic arms. Semin Plast Surg 2015; 29 (01) 62-72
• 10 Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res 2014; 472 (10) 2984-2990
• 11 Pierce Jr RO, Kernek CB, Ambrose II TA. The plight of the traumatic amputee. Orthopedics 1993; 16 (07) 793-797
• 12 Hanley MA, Ehde DM, Jensen M. et al. Chronic pain associated with upper-limb loss. Am J Phys Med Rehabil 2009; 88: 742-751 ; quiz 52, 79
• 13 Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983; 17 (03) 243-256
• 14 Jensen TS, Krebs B, Nielsen J, Rasmussen P. Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 1985; 21 (03) 267-278
• 15 Vaso A, Adahan HM, Gjika A. et al. Peripheral nervous system origin of phantom limb pain. Pain 2014; 155 (07) 1384-1391
• 16 Sadosky A, McDermott AM, Brandenburg NA, Strauss M. A review of the epidemiology of painful diabetic peripheral neuropathy, postherpetic neuralgia, and less commonly studied neuropathic pain conditions. Pain Pract 2008; 8 (01) 45-56
• 17 Preissler S, Feiler J, Dietrich C, Hofmann GO, Miltner WH, Weiss T. Gray matter changes following limb amputation with high and low intensities of phantom limb pain. Cereb Cortex 2013; 23 (05) 1038-1048
• 18 Nikolajsen L, Staehelin Jensen T. Phantom limb pain. Curr Rev Pain 2000; 4 (02) 166-170
• 19 Montoya P, Ritter K, Huse E. et al. The cortical somatotopic map and phantom phenomena in subjects with congenital limb atrophy and traumatic amputees with phantom limb pain. Eur J Neurosci 1998; 10 (03) 1095-1102
• 20 Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity?. Nat Rev Neurosci 2006; 7 (11) 873-881
• 21 Flor H, Elbert T, Knecht S. et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 1995; 375 (6531) 482-484
• 22 Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 2005; 86 (10) 1910-1919
• 23 Buchheit T, Van de Ven T, Hsia HL. et al. Pain phenotypes and associated clinical risk factors following traumatic amputation: results from Veterans Integrated Pain Evaluation Research (VIPER). Pain Med 2016; 17 (01) 149-161
• 24 Tintle SM, Baechler MF, Nanos GP, Forsberg JA, Potter BK. Reoperations following combat-related upper-extremity amputations. J Bone Joint Surg Am 2012; 94 (16) e1191-e1196
• 25 Hsu E, Cohen SP. Postamputation pain: epidemiology, mechanisms, and treatment. J Pain Res 2013; 6: 121-136
• 26 Bowen JB, Wee CE, Kalik J, Valerio IL. Targeted muscle reinnervation to improve pain, prosthetic tolerance, and bioprosthetic outcomes in the amputee. Adv Wound Care (New Rochelle) 2017; 6 (08) 261-267
• 27 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (03) 422-429
• 28 Dumanian GA, Ko JH, O'Shaughnessy KD, Kim PS, Wilson CJ, Kuiken TA. Targeted reinnervation for transhumeral amputees: current surgical technique and update on results. Plast Reconstr Surg 2009; 124 (03) 863-869
• 29 Hargrove LJ, Miller LA, Turner K, Kuiken TA. Myoelectric pattern recognition outperforms direct control for transhumeral amputees with targeted muscle reinnervation: a randomized clinical trial. Sci Rep 2017; 7 (01) 13840
• 30 O'Shaughnessy KD, Dumanian GA, Lipschutz RD, Miller LA, Stubblefield K, Kuiken TA. Targeted reinnervation to improve prosthesis control in transhumeral amputees. A report of three cases. J Bone Joint Surg Am 2008; 90 (02) 393-400
• 31 Kuiken TA, Barlow AK, Hargrove L, Dumanian GA. Targeted muscle reinnervation for the upper and lower extremity. Tech Orthop 2017; 32 (02) 109-116
• 32 Woo SL, Kung TA, Brown DL, Leonard JA, Kelly BM, Cederna PS. Regenerative peripheral nerve interfaces for the treatment of postamputation neuroma pain: a pilot study. Plast Reconstr Surg Glob Open 2016; 4 (12) e1038
• 33 Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2014; 2014 (04) CD005451
• 34 Valerio IL, Dumanian GA, Jordan SW. et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg 2019; 228 (03) 217-226
• 35 Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci 1996; 263 (1369) 377-386
• 36 Moore A. Gabapentin and post tonsillectomy pain-the next best thing?. Arch Trauma Res 2013; 1 (04) 188-190
• 37 Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg 1985; 76 (03) 345-353
• 38 Lu C, Sun X, Wang C, Wang Y, Peng J. Mechanisms and treatment of painful neuromas. Rev Neurosci 2018; 29 (05) 557-566
• 39 Lanier ST, Jordan SW, Ko JH, Dumanian GA. Targeted muscle reinnervation as a solution for nerve pain. Plast Reconstr Surg 2020; 146 (05) 651e-663e
• 40 Kung TA, Langhals NB, Martin DC, Johnson PJ, Cederna PS, Urbanchek MG. Regenerative peripheral nerve interface viability and signal transduction with an implanted electrode. Plast Reconstr Surg 2014; 133 (06) 1380-1394
• 41 Kubiak CA, Kemp SWP, Cederna PS. Regenerative peripheral nerve interface for management of postamputation neuroma. JAMA Surg 2018; 153 (07) 681-682
• 42 Ives GC, Kung TA, Nghiem BT. et al. Current state of the surgical treatment of terminal neuromas. Neurosurgery 2018; 83 (03) 354-364
• 43 Huse E, Larbig W, Flor H, Birbaumer N. The effect of opioids on phantom limb pain and cortical reorganization. Pain 2001; 90 (1-2): 47-55
• 44 Gorkisch K, Boese-Landgraf J, Vaubel E. Treatment and prevention of amputation neuromas in hand surgery. Plast Reconstr Surg 1984; 73 (02) 293-299
• 45 Eccleston C, Hearn L, Williams AC. Psychological therapies for the management of chronic neuropathic pain in adults. Cochrane Database Syst Rev 2015; 2015 (10) CD011259
• 46 Dellon AL, Mackinnon SE, Pestronk A. Implantation of sensory nerve into muscle: preliminary clinical and experimental observations on neuroma formation. Ann Plast Surg 1984; 12 (01) 30-40
• 47 Boldrey E. Amputation neuroma in nerves implanted in bone. Ann Surg 1943; 118 (06) 1052-1057
• 48 Bittar RG, Otero S, Carter H, Aziz TZ. Deep brain stimulation for phantom limb pain. J Clin Neurosci 2005; 12 (04) 399-404
• 49 Baron R. Neuropathic pain: a clinical perspective. Handb Exp Pharmacol 2009; (194) 3-30
• 50 Alviar MJ, Hale T, Dungca M. Pharmacologic interventions for treating phantom limb pain. Cochrane Database Syst Rev 2011; (12) CD006380
• 51 Poppler LH, Parikh RP, Bichanich MJ. et al. Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Pain 2018; 159 (02) 214-223
• 52 Wang X, Yi Y, Tang D. et al. Gabapentin as an adjuvant therapy for prevention of acute phantom-limb pain in pediatric patients undergoing amputation for malignant bone tumors: a prospective double-blind randomized controlled trial. J Pain Symptom Manage 2018; 55 (03) 721-727
• 53 Herrador Colmenero L, Perez Marmol JM, Martí-García C. et al. Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: a systematic review. Prosthet Orthot Int 2018; 42 (03) 288-298
• 54 Bosanquet DC, Glasbey JC, Stimpson A, Williams IM, Twine CP. Systematic review and meta-analysis of the efficacy of perineural local anaesthetic catheters after major lower limb amputation. Eur J Vasc Endovasc Surg 2015; 50 (02) 241-249
• 55 Mioton LM, Dumanian GA, Shah N. et al. Targeted muscle reinnervation improves residual limb pain, phantom limb pain, and limb function: a prospective study of 33 major limb amputees. Clin Orthop Relat Res 2020; 478 (09) 2161-2167
• 56 Yao J, Chen A, Kuiken T, Carmona C, Dewald J. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: a case report. Neuroimage Clin 2015; 8: 329-336
• 57 Serino A, Akselrod M, Salomon R. et al. Upper limb cortical maps in amputees with targeted muscle and sensory reinnervation. Brain 2017; 140 (11) 2993-3011
• 58 Preißler S, Thielemann D, Dietrich C, Hofmann GO, Miltner WHR, Weiss T. Preliminary evidence for training-induced changes of morphology and phantom limb pain. Front Hum Neurosci 2017; 11: 319
• 59 Lotze M, Grodd W, Birbaumer N, Erb M, Huse E, Flor H. Does use of a myoelectric prosthesis prevent cortical reorganization and phantom limb pain?. Nat Neurosci 1999; 2 (06) 501-502
• 60 Kim PS, Ko JH, O'Shaughnessy KK, Kuiken TA, Pohlmeyer EA, Dumanian GA. The effects of targeted muscle reinnervation on neuromas in a rabbit rectus abdominis flap model. J Hand Surg Am 2012; 37 (08) 1609-1616
• 61 Farina D, Castronovo AM, Vujaklija I. et al. Common synaptic input to motor neurons and neural drive to targeted reinnervated muscles. J Neurosci 2017; 37 (46) 11285-11292
• 62 Chen A, Yao J, Kuiken T, Dewald JP. Cortical motor activity and reorganization following upper-limb amputation and subsequent targeted reinnervation. Neuroimage Clin 2013; 3: 498-506
• 63 Peters BR, Russo SA, West JM, Moore AM, Schulz SA. Targeted muscle reinnervation for the management of pain in the setting of major limb amputation. SAGE Open Med 2020; 8: 2050312120959180
• 64 Stoehr JR, Sood R, Jordan SW, Dumanian GA. Targeted muscle reinnervation at the time of amputation in the management of complex regional pain syndrome of the lower extremity. Microsurgery 2020; 40 (08) 852-858
• 65 Pet MA, Ko JH, Friedly JL, Mourad PD, Smith DG. Does targeted nerve implantation reduce neuroma pain in amputees?. Clin Orthop Relat Res 2014; 472 (10) 2991-3001
• 66 Michno DA, Woollard ACS, Kang NV. Clinical outcomes of delayed targeted muscle reinnervation for neuroma pain reduction in longstanding amputees. J Plast Reconstr Aesthet Surg 2019; 72 (09) 1576-1606
• 67 Cheesborough JE, Souza JM, Dumanian GA, Bueno Jr RA. Targeted muscle reinnervation in the initial management of traumatic upper extremity amputation injury. Hand (N Y) 2014; 9 (02) 253-257
• 68 Hoyt BW, Gibson JA, Potter BK, Souza JM. Practice patterns and pain outcomes for targeted muscle reinnervation: an informed approach to targeted muscle reinnervation use in the acute amputation setting. J Bone Joint Surg Am 2021; 103 (08) 681-687
• 69 Pierrie SN, Gaston RG, Loeffler BJ. Targeted muscle reinnervation for prosthesis optimization and neuroma management in the setting of transradial amputation. J Hand Surg Am 2019; 44: 525.e1-e8
• 70 Chang BL, Mondshine J, Attinger CE, Kleiber GM. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg 2021; 148 (02) 376-386
• 71 Wolvetang NHA, Lans J, Verhiel SHWL, Notermans BJW, Chen NC, Eberlin KR. Surgery for symptomatic neuroma: anatomic distribution and predictors of secondary surgery. Plast Reconstr Surg 2019; 143 (06) 1762-1771
• 72 Oh C, Carlsen BT. New innovations in targeted muscle reinnervation: a critical analysis review. JBJS Rev 2019; 7 (06) e3
• 73 Guse DM, Moran SL. Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: a 25-year comparative outcome study. Ann Plast Surg 2013; 71 (06) 654-658
• 74 Eberlin KR, Ducic I. Surgical algorithm for neuroma management: a changing treatment paradigm. Plast Reconstr Surg Glob Open 2018; 6 (10) e1952
• 75 Chang BL, Harbour P, Mondshine J, Kleiber GM. Targeted muscle reinnervation to expendable motor nerves for the treatment of refractory symptomatic neuromas in nonamputees. Plast Reconstr Surg Glob Open 2021; 9 (02) e3436
• 76 Eberlin KR, Brown DA, Gaston RG. et al. A consensus approach for targeted muscle reinnervation in amputees. Plast Reconstr Surg Glob Open 2023; 11 (04) e4928
• 77 Morgan EN, Kyle Potter B, Souza JM, Tintle SM, Nanos III GP. Targeted muscle reinnervation for transradial amputation: description of operative technique. Tech Hand Up Extrem Surg 2016; 20 (04) 166-171
• 78 Mioton LM, Dumanian GA. Targeted muscle reinnervation and prosthetic rehabilitation after limb loss. J Surg Oncol 2018; 118 (05) 807-814
• 79 Lans J, Groot OQ, Hazewinkel MHJ. et al. Factors related to neuropathic pain following lower extremity amputation. Plast Reconstr Surg 2022; 150 (02) 446-455
• 80 Lans J, Hoftiezer Y, Lozano-Calderón SA, Heng M, Valerio IL, Eberlin KR. Risk factors for neuropathic pain following major upper extremity amputation. J Reconstr Microsurg 2021; 37 (05) 413-420
• 81 Gart MS, Souza JM, Dumanian GA. Targeted muscle reinnervation in the upper extremity amputee: a technical roadmap. J Hand Surg Am 2015; 40 (09) 1877-1888
• 82 Daly MC, He JJ, Ponton RP, Ko JH, Valerio IL, Eberlin KR. A single incision anterior approach for transhumeral amputation targeted muscle reinnervation. Plast Reconstr Surg Glob Open 2020; 8 (04) e2750
• 83 Fracol ME, Janes LE, Ko JH, Dumanian GA. Targeted muscle reinnervation in the lower leg: an anatomical study. Plast Reconstr Surg 2018; 142 (04) 541e-550e
• 84 Agnew SP, Schultz AE, Dumanian GA, Kuiken TA. Targeted reinnervation in the transfemoral amputee: a preliminary study of surgical technique. Plast Reconstr Surg 2012; 129 (01) 187-194
• 85 McInnes CW, Ha AY, Power HA, Tung TH, Moore AM. Femoral nerve decompression and sartorius-to-quadriceps nerve transfers for partial femoral nerve injury: a cadaveric study and early case series. J Neurosurg 2020; 135 (03) 904-911
• 86 Pascale BA, Potter BK. Residual limb complications and management strategies. Curr Phys Med Rehabil Rep 2014; 2: 241-249
• 87 Shammas RL, Azoury SC, Sergesketter AR. et al. Primary targeted muscle reinnervation after below-knee amputation is not associated with an increased risk of major or minor surgical complications: a multi-institutional, propensity score-matched analysis. Plast Reconstr Surg 2022; 150 (03) 589-598
• 88 Chang BL, Kleiber GM. Below-the-knee amputation with targeted muscle reinnervation: operative technique and technical pearls. Plast Reconstr Surg Glob Open 2023; 11 (03) e4663
• 89 Janes LE, Fracol ME, Dumanian GA, Ko JH. Targeted muscle reinnervation for the treatment of neuroma. Hand Clin 2021; 37 (03) 345-359
• 90 Fracol ME, Janes LE, Jordan SW. et al. Targeted muscle reinnervation in amputees: a review of current techniques. Tech Orthop 2021; 36: 329-336
• 91 Bowen JB, Ruter D, Wee C, West J, Valerio IL. Targeted muscle reinnervation technique in below-knee amputation. Plast Reconstr Surg 2019; 143 (01) 309-312
• 92 van der Avoort DJ, Hovius SE, Selles RW, van Neck JW, Coert JH. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients. J Plast Reconstr Aesthet Surg 2013; 66 (10) 1330-1334
• 93 Vlot MA, Wilkens SC, Chen NC, Eberlin KR. Symptomatic neuroma following initial amputation for traumatic digital amputation. J Hand Surg Am 2018; 43 (01) 86.e1-86.e8
• 94 Daugherty THF, Bueno Jr RA, Neumeister MW. Novel use of targeted muscle reinnervation in the hand for treatment of recurrent symptomatic neuromas following digit amputations. Plast Reconstr Surg Glob Open 2019; 7 (08) e2376
• 95 Chepla KJ, Wu-Fienberg Y. Targeted muscle reinnervation for partial hand amputation. Plast Reconstr Surg Glob Open 2020; 8 (06) e2946
• 96 Hur MS. Variations of lumbrical muscle innervation patterns in the hand, focusing on the dual innervation of the third lumbrical muscle. Muscle Nerve 2017; 55 (02) 160-165
• 97 Langeveld M, Bruin LL, Hundepool CA, Power D, Duraku LS, Zuidam JM. Anatomy of the superficial radial nerve and its target nerves for targeted muscle reinnervation: an anatomical cadaver study. Plast Reconstr Surg 2024; 153 (01) 95e-100e
• 98 Cox HG, Gary CS, Kleiber GM. Treatment of refractory radial sensory neuroma with function-sparing targeted muscle reinnervation to the extensor carpi radialis brevis. J Hand Surg Glob Online 2022; 5 (01) 112-115
• 99 Grome LJ, Agrawal NA, Wang E, Netscher DT. Targeted muscle reinnervation for symptomatic neuromas utilizing the terminal anterior interosseous nerve. Plast Reconstr Surg Glob Open 2020; 8 (07) e2979
• 100 Janes LE, Fracol ME, Ko JH, Dumanian GA. Management of unreconstructable saphenous nerve injury with targeted muscle reinnervation. Plast Reconstr Surg Glob Open 2020; 8 (01) e2383
• 101 Fracol ME, Dumanian GA, Janes LE, Bai J, Ko JH. Management of sural nerve neuromas with targeted muscle reinnervation. Plast Reconstr Surg Glob Open 2020; 8 (01) e2545
• 102 Chappell AG, Yang CS, Dumanian GA. Surgical treatment of abdominal wall neuromas. Plast Reconstr Surg Glob Open 2021; 9 (05) e3585
• 103 Aroori S, Spence RA. Chronic pain after hernia surgery–an informed consent issue. Ulster Med J 2007; 76 (03) 136-140
• 104 Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. Br J Surg 1999; 86 (12) 1528-1531
• 105 O'Brien AL, Kraft CT, Valerio IL, Rendon JL, Spitz JA, Skoracki RJ. Targeted muscle reinnervation following breast surgery: a novel technique. Plast Reconstr Surg Glob Open 2020; 8 (04) e2782
• 106 Kraft CT, O'Brien AL, Skoracki RJ. Postmastectomy pain syndrome: a primer for plastic surgeons. Ann Plast Surg 2020; 84 (05) 608-610
• 107 Gärtner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009; 302 (18) 1985-1992
• 108 Sarhadi NS, Shaw Dunn J, Lee FD, Soutar DS. An anatomical study of the nerve supply of the breast, including the nipple and areola. Br J Plast Surg 1996; 49 (03) 156-164
• 109 Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain 2003; 104 (1–2): 1-13
• 110 Jaspars JJ, Posma AN, van Immerseel AA, Gittenberger-de Groot AC. The cutaneous innervation of the female breast and nipple-areola complex: implications for surgery. Br J Plast Surg 1997; 50 (04) 249-259
• 111 Andersen KG, Kehlet H. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. J Pain 2011; 12 (07) 725-746
• 112 Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 2017; 139 (05) 1046e-1055e
• 113 Geary M, Gaston RG, Loeffler B. Surgical and technological advances in the management of upper limb amputees. Bone Joint J 2021; 103-B [phone]
• 114 Aman M, Festin C, Sporer ME. et al. Bionic reconstruction: Restoration of extremity function with osseointegrated and mind-controlled prostheses. Wien Klin Wochenschr 2019; 131 (23–24): 599-607
• 115 Vincitorio F, Staffa G, Aszmann OC. et al. Targeted muscle reinnervation and osseointegration for pain relief and prosthetic arm control in a woman with bilateral proximal upper limb amputation. World Neurosurg 2020; 143: 365-373
• 116 Frost CM, Ursu DC, Flattery SM. et al. Regenerative peripheral nerve interfaces for real-time, proportional control of a neuroprosthetic hand. J Neuroeng Rehabil 2018; 15 (01) 108
• 117 Kubiak CA, Kung TA, Brown DL, Cederna PS, Kemp SWP. State-of-the-art techniques in treating peripheral nerve injury. Plast Reconstr Surg 2018; 141 (03) 702-710
• 118 Valerio I, Schulz SA, West J, Westenberg RF, Eberlin KR. Targeted muscle reinnervation combined with a vascularized pedicled regenerative peripheral nerve interface. Plast Reconstr Surg Glob Open 2020; 8 (03) e2689
• 119 Tuffaha SH, Glass C, Rosson G, Shores J, Belzberg A, Wong A. Vascularized, denervated muscle targets: a novel approach to treat and prevent symptomatic neuromas. Plast Reconstr Surg Glob Open 2020; 8 (04) e2779
• 120 Kurlander DE, Wee C, Chepla KJ. et al. TMRpni: Combining two peripheral nerve management techniques. Plast Reconstr Surg Glob Open 2020; 8 (10) e3132