targeted-muscle-reinnervation-surgical-protocol-for-randomized

Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Over the past decade, the field of prosthetics has witnessed significant progress, particularly in the development of surgical techniques to enhance the ...

regenerative-peripheral-nerve-interface-surgical-protocol-for

Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Surgical procedures, including nerve reconstruction and end-organ muscle reinnervation, have become more prominent in the prosthetic field over the past ...

IRCCS Istituto Ortopedico Rizzoli

The posterior trunk has been considered a challenging area to reconstruct following soft tissue tumor excision because of the shortage of local donor sites. The advent of innovative procedures such as perforator flaps has radically changed this perspective and offered a new approach to the problem.

Soft Tissue Reconstruction of the Posterior Trunk after Tumor Excision: A Surgical Algorithm.

Painful conditions such as residual limb pain (RLP) and phantom limb pain (PLP) can manifest after amputation. The mechanisms underlying such postamputation pains are diverse and should be addressed accordingly. Different surgical treatment methods have shown potential for alleviating RLP due to neuroma formation - commonly known as neuroma pain - and to a lesser degree PLP. Two reconstructive surgical interventions, namely targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), are gaining popularity in postamputation pain treatment with promising results. However, these two methods have not been directly compared in a randomised controlled trial (RCT). Here, we present a study protocol for an international, double-blind, RCT to assess the effectiveness of TMR, RPNI, and a non-reconstructive procedure called neuroma transposition (active control) in alleviating RLP, neuroma pain, and PLP.

Surgical treatments for postamputation pain: study protocol for an international, double-blind, randomised controlled trial.

Remnant muscles in the residual limb after amputation are the most common source of control signals for prosthetic hands, because myoelectric signals can be generated by the user at will. However, for individuals with amputation higher up the arm, such as an above-elbow (transhumeral) amputation, insufficient muscles remain to generate myoelectric signals to enable control of the lost arm and hand joints, thus making intuitive control of wrist and finger prosthetic joints unattainable. We show that severed nerves can be divided along their fascicles and redistributed to concurrently innervate different types of muscle targets, particularly native denervated muscles and nonvascularized free muscle grafts. We engineered these neuromuscular constructs with implanted electrodes that were accessible via a permanent osseointegrated interface, allowing for bidirectional communication with the prosthesis while also providing direct skeletal attachment. We found that the transferred nerves effectively innervated their new targets as shown by a gradual increase in myoelectric signal strength. This allowed for individual flexion and extension of all five fingers of a prosthetic hand by a patient with a transhumeral amputation. Improved prosthetic function in tasks representative of daily life was also observed. This proof-of-concept study indicates that motor neural commands can be increased by creating electro-neuromuscular constructs using distributed nerve transfers to different muscle targets with implanted electrodes, enabling improved control of a limb prosthesis.

Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes.

Correction: Surgical treatments for postamputation pain: study protocol for an international, double-blind, randomised controlled trial.

Selective nerve transfers are used in the setting of upper limb amputation to improve myoelectric prosthesis control. This surgical concept is referred to as targeted muscle reinnervation (TMR) and describes the rerouting of the major nerves of the arm onto the motor branches of the residual limb musculature. Aside from providing additional myosignals for prosthetic control, TMR can treat and prevent neuroma pain and possibly also phantom limb pain. This article reviews the history and current applications of TMR in upper limb amputation, with a focus on practical considerations. It further explores and identifies technological innovations to improve the man-machine interface in amputation care, particularly regarding implantable interfaces, such as muscle electrodes and osseointegration. Finally, future clinical directions and possible scientific avenues in this field are presented and critically discussed.

ArticleTotal : 2	Year
Publication title Cited by 5	2024
Publication title Cited by 5	2024

Article	Year
Soft Tissue Reconstruction of the Posterior Trunk after Tumor Excision: A Surgical Algorithm. Cancers\| PubMed ID: 36831556	2023
Surgical treatments for postamputation pain: study protocol for an international, double-blind, randomised controlled trial. Trials\| PubMed ID: 37131180	2023
Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes. Science translational medicine\| PubMed ID: 37437016	2023
Correction: Surgical treatments for postamputation pain: study protocol for an international, double-blind, randomised controlled trial. Trials\| PubMed ID: 37814331	2023
Targeted muscle reinnervation in bionic upper limb reconstruction: current status and future directions. The Journal of hand surgery, European volume\| PubMed ID: 38366374	2024

Paolo Sassu

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