American Society for Peripheral Nerve

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Targeted Muscle Reinnervation after Transhumeral Amputation during Initial Hospitalization
Megan M. Henderson, MD; Michael W. Neumeister, MD, FRCSC, FACS; Reuben A. Bueno Jr, MD
Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL

Introduction: Targeted muscle reinnervation (TMR) has provided a valuable surgical option following traumatic upper extremity amputations by allowing improved prosthetic function under cortical control. Furthermore, transfer of traumatically amputated nerve ends to other nerves may prevent the formation of painful neuromas. Performing nerve surgery in the acute setting avoids dissection of nerve ends in a scarred wound bed, prevents neuroma formation, and prepares amputees for possible myoelectric prosthetic use in the future.

Methods: We present the first known report of acute TMR for a transhumeral amputee.

Results: One year after amputation and nerve transfers, the patient has been successfully fitted with a myoelectric prosthetic under cortical control and demonstrates no clinical evidence of neuroma pain. Pain-related behavior and pain interference were assessed using the Patient Reported Outcomes Measurement Information System (PROMIS).

Conclusions: In the acute setting of traumatic transhumeral amputation, targeted muscle reinnervation can be considered to prevent neuroma pain and to allow future use of a myoelectric prosthesis under cortical control.

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