Does Targeted Nerve Implantation Reduce Neuroma Pain in Amputees?

Abstract

TNI performed either primarily at the time of acute amputation or secondarily for the treatment of established symptomatic neuroma is associated with a low frequency of neuroma-related pain. By providing a distal target for regenerating axons, TNI may offer an effective strategy for the prevention and treatment of neuroma pain in amputees.

Regenerative Peripheral Nerve Interfaces for the Treatment of Postamputation Neuroma Pain: A Pilot Study

“…In addition to RPNI surgery, other neuroma treatments more recently described in the literature include targeted nerve implantation (TNI) 47 and targeted muscle reinnervation (TMR). 48 TNI involves securing nerve endings to transected intramuscular motor nerve branches within surgically denervated muscle in the residual limb.…”

Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

“…Amputation operations with potential to prevent symptomatic neuroma have been described in case series . These operations include techniques to protect nerve endings under the assumption that protection of these endings from repeated post‐amputation trauma will reduce rate of formation and pain evoked from symptomatic neuroma.…”

Traction Neurectomy for Treatment of Painful Residual Limb Neuroma in Lower Extremity Amputees

“…Among the 15 lower extremity amputees we have treated for symptomatic neuroma using this method, recurrent pain was observed in only a single patient. 12 Souza et al 13 have documented relief of neuroma pain in 14 of 15 upper extremity amputees using their related, but distinct, technique of targeted muscle reinnervation.…”

“…The literature abounds with proposed surgical treatments for symptomatic neuroma. Muscle, 4,5 bone, 6,7 or vein implantation, 8,9 centro-central coaptation, 10,11 targeted nerve implantation, 12 and targeted muscle reinnervation, 13 among others, have been advocated based on theoretical arguments and encouraging case series data. However, in the absence of an evidence-based consensus solution, many surgeons have used traction neurectomy as the most straightforward and least invasive surgical technique for neuroma management.…”