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American Association for Hand Surgery

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The Role of Acute Targeted Muscle Reinnervation in Neuropathic Pain Prevention and Neuroma Formation
Evelyn G Goodyear, BS1, Andrew L. O'Brien, MD, MPH2, Julie M West, MS, PA-C2, Maria T Huayllani, MD2, Steven A Schulz, MD2 and Amy M Moore, MD2, (1)The Ohio State University Wexner Medical Center, Columbus, OH, (2)Division of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH

Introduction: Targeted Muscle Reinnervation (TMR) has emerged as a promising technique for the prevention and management of phantom limb pain (PLP) and residual limb pain (RLP) among amputees. The relationship between the timing of TMR and the subsequent formation of painful neuromas is unknown. The purpose of this study was to evaluate whether TMR at the time of amputation (i.e., acute) or TMR performed following symptomatic neuroma formation (i.e., delayed) affects subsequent symptomatic neuroma formation and patient reported pain outcomes.

Methods: A cross-sectional, retrospective chart review was conducted using patients identified as treated with TMR between October 2015 to December 2020 either acutely or following the formation of a symptomatic neuroma. Demographic information, post-operative neuroma outcomes, and surgical complications were collected. RLP and PLP were analyzed using Patient-Reported Outcome Measurement Information System (PROMIS) pain intensity, interference, and behavior as well as an 11-point numeric rating scale (NRS). Opioid, neurotransmitter and prosthetic use information was also collected at the time of survey administration.

Results: One-hundred and five patients were identified who underwent TMR, seventy-three patients underwent acute TMR with an average follow up of 34.5 months compared to thirty-two patients who underwent delayed TMR with an average follow-up of 40 months. Among these patients, 19% of the delayed TMR group had neuromas recur in the distribution of original TMR while only 1% of the acute TMR group had subsequent neuroma formation (Table 1). There was no difference in surgical complication rates between the two groups. 85% of the acute TMR group and 69% of the delayed TMR group completed pain surveys at final follow-up. Of this subanalysis, patients who underwent acute TMR reported significantly lower PLP PROMIS pain interference (p=0.01), RLP PROMIS pain intensity (p=0.03) and RLP PROMIS pain interference (p=0.03) in comparison to the delayed group.

Conclusions: Patients who underwent acute TMR reported improved pain scores and decreased rate of neuroma formation compared to TMR performed in a delayed fashion. These results highlight the promising role of TMR in the prevention of neuropathic pain and neuroma formation when performed at the time of amputation.

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