Outcomes, Challenges, and Pitfalls after Targeted Muscle Reinnervation in High-Level Amputees: Is It Worth the Effort?

Tytuł:: Outcomes, Challenges, and Pitfalls after Targeted Muscle Reinnervation in High-Level Amputees: Is It Worth the Effort?
Autorzy:: Salminger S; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Sturma A; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Roche AD; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Mayer JA; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Gstoettner C; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Aszmann OC; From the Division of Plastic and Reconstructive Surgery and the Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Department of Physical Medicine and Rehabilitation, Medical University of Vienna; and the Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust.
Źródło:: Plastic and reconstructive surgery [Plast Reconstr Surg] 2019 Dec; Vol. 144 (6), pp. 1037e-1043e.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Publication: : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore : Williams & Wilkins,
MeSH Terms:: Amputation, Surgical/*methods
Amputation, Traumatic/*surgery
Arm/*innervation
Muscle, Skeletal/*innervation
Nerve Transfer/*methods
Accidents, Traffic ; Adolescent ; Adult ; Amputation, Surgical/rehabilitation ; Amputation Stumps/innervation ; Amputation, Traumatic/rehabilitation ; Arm/surgery ; Humans ; Lymphatic Abnormalities/surgery ; Male ; Nerve Regeneration/physiology ; Nerve Transfer/rehabilitation ; Treatment Outcome ; Vascular Malformations/surgery ; Young Adult
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Entry Date(s):: Date Created: 20191126 Date Completed: 20200302 Latest Revision: 20240229
Update Code:: 20240229
DOI:: 10.1097/PRS.0000000000006277
PMID:: 31764652
: Czasopismo naukowe

Background: Although the distal targets have been lost in proximal upper limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using targeted muscle reinnervation technique. In this article, the authors present their outcomes and range of indications in addition to experiences and pitfalls after 30 targeted muscle reinnervation cases at above-elbow and shoulder disarticulation level of amputation.
Methods: Thirty patients with above-elbow or shoulder disarticulation amputations were enrolled between 2012 and 2017. Indications for targeted muscle reinnervation surgery differed between improvement of prosthetic function (n = 19) and/or pain (n = 11). Functional outcome was evaluated with the Action Research Arm Test, the Southampton Hand Assessment Procedure, and the Clothespin-Relocation Test. Functional evaluation was performed at least at 6 months after final prosthetic fitting.
Results: All nerve transfers were successful and provided independent myoelectric signals. The 10 patients available for final functional evaluation showed Action Research Arm Test scores of 20.4 ± 1.9 and Southampton Hand Assessment Procedure scores of 40.5 ± 8.1. The Clothespin-Relocation Test showed a mean time of 34.3 ± 14.4 seconds.
Conclusions: Targeted muscle reinnervation has improved prosthetic control and revolutionized neuroma treatment in upper limb amputees. Still, the rate of abandonment even after targeted muscle reinnervation surgery has been shown high, and several advances within the biotechnological interface will be needed to improve prosthetic function and acceptance in these patients.
Clinical Question/level of Evidence: Therapeutic, IV.

Comment in: Plast Reconstr Surg. 2020 May;145(5):1008e-1009e. (PMID: 32332574)
Comment in: Plast Reconstr Surg. 2020 May;145(5):1010e. (PMID: 32332575)

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