Expanding the criteria for targeted muscle reinnervation: A national assessment of eligibility

Junn, Alexandra; Dinis, Jacob; Reátegui, Alvaro; Liu, Shirley; Colen, David L.; Pršić, Adnan

doi:10.1016/j.orthop.2021.10.003

Cited by 8 publications

(5 citation statements)

References 51 publications

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“…Indeed, numerous studies have proved the efficacy of TMR in the prevention of PLP and neuroma formation. 11 , 13 A randomized clinical trial from 2019 demonstrated that TMR resulted in improved residual limb pain and PLP at a 1-year follow-up. 11 Additionally, in a study of 22 below-the-knee amputations, TMR yielded no patients with symptomatic neuromas at 18 months, and 13% with PLP at 6 months.…”

Section: Introductionmentioning

confidence: 99%

“… 11 , 13 A randomized clinical trial from 2019 demonstrated that TMR resulted in improved residual limb pain and PLP at a 1-year follow-up. 11 Additionally, in a study of 22 below-the-knee amputations, TMR yielded no patients with symptomatic neuromas at 18 months, and 13% with PLP at 6 months. 12 TMR has also been shown to reduce postoperative opioid use.…”

Section: Introductionmentioning

confidence: 99%

“… 15 “Immediate TMR” has been previously described as the TMR procedure occurring within 14 days of the patient’s amputation. 11 While studies have shown that TMR at the time of the amputation is optimal, an immediate TMR may be defined as within the 14-day window following the amputation. This allows for the procedure to be performed before a painful neuroma can form, but this window still creates some variability as to when the TMR may be performed.…”

Section: Introductionmentioning

confidence: 99%

“…This technique consists of excising a neuroma (if needed) and reattaching the proximal end of the motor or sensory nerve onto a newly divided distal motor branch of a muscle, allowing the nerve fascicles to grow along the new motor nerve and function as one unit to innervate the target muscle. [10][11][12] In recent years TMR has become a procedure utilized in amputee patients to prevent and manage neuroma formation. Indeed, numerous studies have proved the efficacy of TMR in the prevention of PLP and neuroma formation.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends

Hagopian

Farhat

Doval

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Targeted muscle reinnervation has been adopted as a strategy for the management and prevention of phantom limb pain and symptomatic neuroma formation for patients undergoing lower extremity amputation. The procedure is often performed by surgeons different from those performing the amputation, creating scheduling dilemmas. The purpose of this study was to analyze historic trends in lower extremity amputation scheduling in a single hospital system to evaluate if offering routine immediate targeted muscle reinnervation is practical. Methods: De-identified data over a five-year period for all patients undergoing lower extremity amputation were collected. The data gathered included the specialty performing the amputation, weekly distribution of cases, start time, and end time, among others. Results: A total of 1549 lower extremity amputations were performed. There was no statistically significant difference in average number of below-the-knee amputations (172.8) and above-the-knee amputations (137.4) per year. Top specialties performing amputations were vascular surgery (47.8%), orthopedic surgery (34.5%), and general surgery (13.85%). No significant difference was noted in the average number of amputations across the week, per year. Most cases started between 6 am and 6 pm (96.4%). The average length of stay after surgery was 8.26 days. Conclusions: In a large, nontrauma hospital system, most lower extremity amputations are performed during typical working hours and are evenly distributed throughout the week. Understanding peak timing of amputations may allow for targeted muscle reinnervation to be performed concurrently with amputation procedure. Data presented will be a first step to optimizing amputation scheduling for patients in a large nontrauma health system.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends

Hagopian

Farhat

Doval

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

Raasveld,

Mayrhofer‐Schmid,

Johnston

et al. 2024

Microsurgery

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IntroductionTargeted muscle reinnervation (TMR) has demonstrated efficacy for treatment of neuropathic pain. This study aims to identify patients for whom delayed TMR may be most effective and to identify associated factors for favorable pain outcomes in this patient population.MethodsAn analysis was conducted on prospectively enrolled amputee patients who underwent delayed TMR at a tertiary care center from 2017 to 2024. Data on demographics, comorbidities, surgical details, and pain outcomes were collected. Patient reported pain severity on a 0–10 scale was prospectively collected. The main pain outcome was pain remission (achieving the minimally clinically important difference (MCID)). Additionally, sustained mild pain (pain score ≤ 3/10 for ≥ 3 months), and pain disappearance (pain score 0/10 for ≥ 3 months) were assessed. Multivariable regression analyses identified factors influencing pain outcomes.ResultsOut of 101 patients included in this study, 64 patients (63.4%) achieved pain remission within a two‐year post‐operative period, and 37 patients (36.6%) did not. Sustained mild pain, which could be achieved in addition to pain remission, was achieved by 45.8% of patients, with 17.8% of these achieving complete pain disappearance. Patients achieving pain remission demonstrated lower pain over the entire post‐operative trajectory (p < 0.001). Lower pre‐operative pain scores, absence of depression, no pre‐operative opioid use, lower Elixhauser Comorbidity Index, and distal amputation levels were correlated with favorable outcomes following delayed TMR (p < 0.05).DiscussionPre‐operative pain severity, psychiatric comorbidities, and opioid use significantly influenced pain outcomes, emphasizing the need for comprehensive patient assessment. These findings will help with patient stratification and pre‐operative counseling to support patients who are best suitable for delayed TMR surgery.

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The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis

et al. 2022

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Expanding the criteria for targeted muscle reinnervation: A national assessment of eligibility

Cited by 8 publications

References 51 publications

Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends

Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends

Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees

The effect of targeted muscle reinnervation on post-amputation pain and functional outcomes: a systematic review and meta-analysis

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