Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain
Journal article, 2024
Over the past decade, the field of prosthetics has witnessed significant progress, particularly in the development of surgical techniques to enhance the functionality of prosthetic limbs. Notably, novel surgical interventions have had an additional positive outcome, as individuals with amputations have reported neuropathic pain relief after undergoing such procedures. Subsequently, surgical techniques have gained increased prominence in the treatment of postamputation pain, including one such surgical advancement-targeted muscle reinnervation (TMR). TMR involves a surgical approach that reroutes severed nerves as a type of nerve transfer to "target" motor nerves and their accompanying motor end plates within nearby muscles. This technique originally aimed to create new myoelectric sites for amplified electromyography (EMG) signals to enhance prosthetic intuitive control. Subsequent work showed that TMR also could prevent the formation of painful neuromas as well as reduce postamputation neuropathic pain (e.g., Residual and Phantom Limb Pain). Indeed, multiple studies have demonstrated TMR's effectiveness in mitigating postamputation pain as well as improving prosthetic functional outcomes. However, technical variations in the procedure have been identified as it is adopted by clinics worldwide. The purpose of this article is to provide a detailed step-by-step description of the TMR procedure, serving as the foundation for an international, randomized controlled trial (ClinicalTrials.gov, NCT05009394), including nine clinics in seven countries. In this trial, TMR and two other surgical techniques for managing postamputation pain will be evaluated.
Author
Emily Pettersen
Chalmers, Electrical Engineering
Sahlgrenska University Hospital
IRCCS Istituto Ortopedico Rizzoli, Bologna
Paolo Sassu
IRCCS Istituto Ortopedico Rizzoli, Bologna
Francesca Alice Pedrini
Sahlgrenska University Hospital
IRCCS Istituto Ortopedico Rizzoli, Bologna
Hannes Granberg
Sahlgrenska University Hospital
Carina Reinholdt
Sahlgrenska University Hospital
Juan Manuel Breyer
Worker Hospital
Aidan D. Roche
University of Edinburgh
Andrew Hart
Canniesburn Plastic Surgery Unit
University of Glasgow
Adil Ladak
University of Alberta
Hollie Power
University of Alberta
Michael Leung
Dandenong Hospital
Michael Lo
Dandenong Hospital
Ian Valerio
Harvard Medical School
Kyle R. Eberlin
Harvard Medical School
Theodore A. Kung
University of Michigan
Paul S. Cederna
University of Michigan
Jason M. Souza
Ohio State University
Uniformed Services University of the Health Sciences
Oskar C. Aszmann
Medical University of Vienna
Jason Ko
Northwestern University
Gregory A. Dumanian
Northwestern University
Max Jair Ortiz Catalan
IRCCS Istituto Ortopedico Rizzoli, Bologna
Prometei Pain Rehabilitation Center
University of Melbourne
Sahlgrenska University Hospital
Journal of Visualized Experiments
1940-087X (ISSN)
Vol. 2024 205 e66379Subject Categories
Physiotherapy
Cardiac and Cardiovascular Systems
Neurology
DOI
10.3791/66379