Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees
Summary:. Symptomatic neuromas can cause debilitating pain, significantly impairing patients’ quality of life. There are numerous medical and surgical options for management. Targeted muscle reinnervation (TMR) is a nerve transfer procedure that is now commonly used to prevent or treat symptomatic n...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-02-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003436 |
| _version_ | 1819172503325507584 |
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| author | Brian L. Chang, MD Patrick Harbour, MD Josh Mondshine, BS Grant M. Kleiber, MD |
| author_facet | Brian L. Chang, MD Patrick Harbour, MD Josh Mondshine, BS Grant M. Kleiber, MD |
| author_sort | Brian L. Chang, MD |
| collection | DOAJ |
| description | Summary:. Symptomatic neuromas can cause debilitating pain, significantly impairing patients’ quality of life. There are numerous medical and surgical options for management. Targeted muscle reinnervation (TMR) is a nerve transfer procedure that is now commonly used to prevent or treat symptomatic neuromas or phantom limb pain in amputees. There are a few reports in the current literature about performing TMR in the nonamputee, but no cohort studies to date that report pain outcomes. This study evaluates TMR to treat symptomatic neuromas in nonamputee patients. This is a retrospective cohort study of all patients with symptomatic neuromas treated with TMR over a 1-year period from January 1,2019, to January 1, 2020, at MedStar Georgetown University Hospital. The neuromas are excised to healthy nerve fascicles, and a redundant donor motor fascicle is selected for nerve transfer. Patients were asked in clinic or via telephone about their preoperative and postoperative pain, function, and quality of life, and postoperative clinic notes were reviewed for complications and motor deficits. Fifteen patients were included in this study. Patients had symptomatic neuromas involving the upper extremity, lower extremity, and trunk. Pain frequency decreased from 6.7 times per week to 3.9 (P < 0.01) and from 9.1 times per day to 5.1 (P < 0.01). Pain severity decreased from an average of 7.9/10 to 4.3/10 (P < 0.01). Overall physical function increased from 3.7/10 to 5.8/10 (P = 0.01), and overall quality of life increased from 4.9/10 to 7.0/10 (P < 0.01). No patients had demonstrable weakness of the motor function of the donor nerve. Targeted muscle reinnervation is a viable surgical option for the treatment of symptomatic neuromas, particularly in those patients who have previously failed prior neuroma excisions. |
| first_indexed | 2024-12-22T20:08:13Z |
| format | Article |
| id | doaj.art-337ea5215b6d4e78ac1bd671eb508309 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-22T20:08:13Z |
| publishDate | 2021-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-337ea5215b6d4e78ac1bd671eb5083092022-12-21T18:14:06ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-02-0192e343610.1097/GOX.0000000000003436202102000-00019Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in NonamputeesBrian L. Chang, MD0Patrick Harbour, MD1Josh Mondshine, BS2Grant M. Kleiber, MD3From the * Department of Plastic Surgery, MedStar Georgetown University Hospital; Washington, D.C.† Department of Plastic Surgery, MedStar Georgetown University Hospital; Washington, D.C.‡ Georgetown University School of Medicine, Washington, D.C.§ Department of Plastic Surgery, MedStar Georgetown University Hospital; Washington, D.C.Summary:. Symptomatic neuromas can cause debilitating pain, significantly impairing patients’ quality of life. There are numerous medical and surgical options for management. Targeted muscle reinnervation (TMR) is a nerve transfer procedure that is now commonly used to prevent or treat symptomatic neuromas or phantom limb pain in amputees. There are a few reports in the current literature about performing TMR in the nonamputee, but no cohort studies to date that report pain outcomes. This study evaluates TMR to treat symptomatic neuromas in nonamputee patients. This is a retrospective cohort study of all patients with symptomatic neuromas treated with TMR over a 1-year period from January 1,2019, to January 1, 2020, at MedStar Georgetown University Hospital. The neuromas are excised to healthy nerve fascicles, and a redundant donor motor fascicle is selected for nerve transfer. Patients were asked in clinic or via telephone about their preoperative and postoperative pain, function, and quality of life, and postoperative clinic notes were reviewed for complications and motor deficits. Fifteen patients were included in this study. Patients had symptomatic neuromas involving the upper extremity, lower extremity, and trunk. Pain frequency decreased from 6.7 times per week to 3.9 (P < 0.01) and from 9.1 times per day to 5.1 (P < 0.01). Pain severity decreased from an average of 7.9/10 to 4.3/10 (P < 0.01). Overall physical function increased from 3.7/10 to 5.8/10 (P = 0.01), and overall quality of life increased from 4.9/10 to 7.0/10 (P < 0.01). No patients had demonstrable weakness of the motor function of the donor nerve. Targeted muscle reinnervation is a viable surgical option for the treatment of symptomatic neuromas, particularly in those patients who have previously failed prior neuroma excisions.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003436 |
| spellingShingle | Brian L. Chang, MD Patrick Harbour, MD Josh Mondshine, BS Grant M. Kleiber, MD Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees Plastic and Reconstructive Surgery, Global Open |
| title | Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees |
| title_full | Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees |
| title_fullStr | Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees |
| title_full_unstemmed | Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees |
| title_short | Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Nonamputees |
| title_sort | targeted muscle reinnervation to expendable motor nerves for the treatment of refractory symptomatic neuromas in nonamputees |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003436 |
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