Stump problems in traumatic amputation.

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Abstract

[Indexed for MEDLINE] 10. Hand (N Y). 2025 Nov;20(8):1197-1206. doi: 10.1177/15589447241284811. Epub 2024 Oct 29. Targeted Muscle Reinnervation Compared to Standard Peripheral Nerve Management Following Amputation: A Systematic Review and Meta-Analysis. Zimbulis AJ(1), An VVG(2), Symes M(2)(3)(4), Duraku LS(5)(6), Gaston RG(7), Eberlin KR(8)(9), Sivakumar B(10)(11)(12)(13)(14). Author information: (1)University of Notre Dame School of Medicine, Darlinghurst, New South Wales, Australia. (2)Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia. (3)Department of Orthopaedic Surgery, St George Hospital, Kogarah, New South Wales, Australia. (4)Sydney Orthopaedic Foot and Ankle Research Institute (SOFARI), Sydney, New South Wales, Australia. (5)The Hand & Peripheral Nerve Injury Department, University Hospitals Birmigham NHS Foundation Trust, Birmingham, UK. (6)Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Amsterdam, the Netherlands. (7)OrthoCarolina Hand Center, Charlotte, NC, USA. (8)Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA. (9)Harvard Medical School, Boston, MA, USA. (10)Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, The University of Sydney, Australia. (11)Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Queensland, Australia. (12)Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia. (13)Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia. (14)Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, New South Wales, Australia. BACKGROUND: Chronic pain remains a significant challenge for individuals following limb amputation, with incidence of painful neuromas, phantom limb pain (PLP), and residual limb pain (RLP). Targeted muscle reinnervation (TMR) is a surgical technique designed to restore motor control information lost during amputation by redirecting residual nerves to new muscle targets. This systematic review and meta-analysis aims to compare patient-reported and functional outcomes following amputation with either TMR or standard neurological treatment (SNT). The study also includes an examination of primary versus secondary TMR and explores outcomes in highly comorbid patient populations. METHODS: A search of central databases was performed, and meta-analysis was completed on extracted data where possible. RESULTS: Eleven studies were identified. Results indicate a significant reduction in PLP and RLP in patients undergoing TMR compared to SNT using various pain scores. TMR also demonstrates improved functional outcomes and decreased opioid use. Furthermore, results indicated patients who underwent TMR at the time of amputation (primary TMR) had improved pain scores compared with those who had TMR performed later (secondary TMR). CONCLUSIONS: The review emphasizes the benefits of TMR as a valuable surgical adjunct for amputee patients, while also highlighting the need for further research, especially in comorbid populations. DOI: 10.1177/15589447241284811 PMCID: PMC11559798