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Below-the-knee Amputation with Targeted Muscle Reinnervation: Operative Technique and Technical Pearls.

MedStar author(s):

Citation: Plastic and Reconstructive Surgery - Global Open. 11(3):e4663, 2023 Mar.PMID: 36998533Department: MedStar Georgetown University Hospital/MedStar Washington Hospital Center | Plastic Surgery Residency LForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: Year: 2023 ISSN:

2169-7574

Name of journal: Plastic and reconstructive surgery. Global openAbstract: Conclusion: This article details our institution's approach to physiologic nerve stabilization via TMR at time of below-the-knee amputation. Copyright Â© 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.Methods: This article details our institution's technique that has been performed safely and effectively on over 100 patients. Our approach and rationale for each of the major nerves of the lower extremity are presented.Postamputation pain from symptomatic neuromas and/or phantom limb pain can have a significant detrimental impact on patients' quality of life following a major lower extremity amputation. Various methods of physiologic nerve stabilization, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface, have been proposed as the best current techniques to prevent that pathologic neuropathic pain.Results: In contrast to other described techniques for TMR for below-the-knee amputations, this current protocol does not involve performing transfers on all five major nerves, as one must balance rates of symptomatic neuroma formation and nerve-specific phantom limb pain with needed operative time and surgical morbidity from removing proximal sensory function and denervation of the donor motor nerve branches. This technique also differs significantly from others by performing a transposition of the superficial peroneal nerve to place the neurorrhaphy away from the weight-bearing stump.All authors: Chang BL, Kleiber GMFiscal year: FY2023 Digital Object Identifier:

https://dx.doi.org/10.1097/GOX.0000000000004663

Date added to catalog: 2023-06-26

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Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	36998533	Available		36998533

Conclusion: This article details our institution's approach to physiologic nerve stabilization via TMR at time of below-the-knee amputation. Copyright Â© 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

Methods: This article details our institution's technique that has been performed safely and effectively on over 100 patients. Our approach and rationale for each of the major nerves of the lower extremity are presented.

Postamputation pain from symptomatic neuromas and/or phantom limb pain can have a significant detrimental impact on patients' quality of life following a major lower extremity amputation. Various methods of physiologic nerve stabilization, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface, have been proposed as the best current techniques to prevent that pathologic neuropathic pain.

Results: In contrast to other described techniques for TMR for below-the-knee amputations, this current protocol does not involve performing transfers on all five major nerves, as one must balance rates of symptomatic neuroma formation and nerve-specific phantom limb pain with needed operative time and surgical morbidity from removing proximal sensory function and denervation of the donor motor nerve branches. This technique also differs significantly from others by performing a transposition of the superficial peroneal nerve to place the neurorrhaphy away from the weight-bearing stump.

English