Targeted muscle reinnervation found safe, efficacious for pain relief in limb amputees
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Researchers found targeted muscle reinnervation used in military patients at the time of primary amputation or delayed amputation was safe and efficacious as a pain treatment method.
“The most frequently symptomatic nerves that warrant nerve interface procedures are specific to the amputation level. This may guide decision-making for inclusion of [targeted muscle reinnervation] TMR and [regenerative peripheral nerve interface] RPNI at the time of the initial amputation. Failure to address these nerves may result in an increased likelihood of subsequent revision surgery,” Lt. Jeffrey A. Gibson, DO, said at the American Society for Surgery of the Hand Annual Meeting, which was held virtually.
At the meeting, Gibson, of Walter Reed Department of Surgery in Bethesda, Maryland, presented results of the retrospective study, which involved a review of electronic medical records.
Researchers found that, among 60 men and 14 women in the military who underwent 87 TMR procedures — 28 acute and 59 delayed surgeries — following 80 lower extremity amputations, nerves that needed to be addressed most frequently due to symptoms of painful neuroma or phantom limb pain were tibial and common peroneal nerves proximal to the knee, as well as the common peroneal, tibial and sural nerves distal to the knee.
Patients’ main mechanism of injury was a traumatic blast injury, according to Gibson.
Patients were treated between January 2014 and December 2019 at a tertiary military referral center and underwent TMR and/or RPNI.
“Procedures were most frequently performed for two to three nerves,” Gibson said.
“Mean VAS pain scores decreased significantly after surgery in both the delayed and the acute group. While the final pain levels were lower for the acute group, this did not reach statistical significance. Additionally, there was no significant difference in pain outcomes when RPNI was used as part of the nerve intervention. In the delayed cohort, opiate and antiepileptic medication use decreased substantially by 6 months postoperatively in total,” he said.
Six patients, all of whom were in the delayed surgery group, underwent seven revision procedures for persistent neurologic symptoms. Their affected nerves were the tibial or common peroneal nerves, or both of these.
“Only one patient experienced a postoperative complication, which was a hematoma necessitating operative intervention,” Gibson said.
“Our current practice for TMR or RNPI at the time of the amputation is informed by these findings and procedures,” he said.
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Gibson JA, et al. Paper 24. Presented at: American Society for Surgery of the Hand Annual Meeting; Oct. 1-3, 2020 (virtual meeting).
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