Abstract
Background Secondary to vascular disease, oncological resection, or devastating trauma, lower
extremity amputations are performed globally at a yearly rate exceeding 1 million
patients. Three-quarters of these patients will develop chronic pain or phantom pain,
which presents a functional limitation for prosthetic use and contributes to deconditioning
and increased mortality. Targeted muscle reinnervation (TMR) presents a surgical solution
to this problem as either a primary or secondary intervention.
Methods A review of the existing literature was conducted using a combination of the terms
“phantom pain” “chronic pain,” “neuroma,” and “targeted muscle reinnervation” in Medline
and PubMed.
Results Five articles were found which addressed TMR for pain syndromes, four of which involved
lower extremity amputation. Four of the articles were retrospective reviews, and one
was a randomized control trial. A total of 149 patients were included, of which 82
underwent lower extremity amputation. Ninety-two of the patients underwent prophylactic
TMR, of which 57 were secondary procedures.
In patients who underwent TMR at the time of amputation, all studies reported a minimal
development of symptomatic neuromas (27%). For secondary TMR, near-complete resolution
of previous pain was found (90%). Phantom pain was noted to be similar to other studies
in the literature but noted to improve over time with both primary (average drop of
3.5 out of 10 points on the numerical rating scale) and secondary (diminishing from
72% of patients to 13% over 6 months) operations.
Conclusion Although much of the current literature is limited to retrospective studies with
few patients, these data point toward near-complete resolution of neuroma pain after
treatment as well as complete prevention of chronic pain if TMR is used as a prophylactic
measure during the index amputation.
This study was a level of evidence IV.
Keywords
nerve - targeted muscle reinnervation - lower extremity
