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Toyoda et al. Plast Aesthet Res 2022;9:17 Plastic and
DOI: 10.20517/2347-9264.2021.118
Aesthetic Research

Review Open Access

Lower extremity amputation: the emerging role of
targeted muscle reinnervation (TMR) and

regenerative peripheral nerve interface (RPNI)

3
1
2
1
Yoshiko Toyoda , Said Azoury , Andrew Bauder , L. Scott Levin , Stephen Kovach 1,3
1
Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
2
Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
3
Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Correspondence to: Dr. Yoshiko Toyoda, Division of Plastic and Reconstructive Surgery, University of Pennsylvania, 3400 Civic
Center Boulevard, Philadelphia, PA 19104, USA. E-mail: Yoshiko.Toyoda@Pennmedicine.upenn.edu
How to cite this article: Toyoda Y, Azoury S, Bauder A, Levin LS, Kovach S. Lower extremity amputation: the emerging role of
targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI). Plast Aesthet Res 2022;9:17.
https://dx.doi.org/10.20517/2347-9264.2021.118

Received: 27 Oct 2021 First Decision: 6 Dec 2021 Revised: 11 Dec 2021 Accepted: 7 Jan 2022 Published: 12 Mar 2022
Academic Editors: Matthew L Iorio, Shailesh Agarwal Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Lower extremity amputation is increasingly prevalent in the United States, with growing numbers of patients
suffering from diabetes and peripheral vascular disease. Amputation has significant functional sequelae as more
than half of patients are unable to ambulate at one year postoperatively. Improving mobility and decreasing chronic
post-amputation pain can significantly improve the quality of life for these patients and reduce the cost burden on
the healthcare system. Plastic and reconstructive surgery has been at the forefront of “reconstructive amputation”,
in which nerve pedicles can be surgically guided to decrease painful neuroma formation as well as provide targets
for myoelectric prosthesis use. We herein review post-amputation outcomes, epidemiology of chronic, post-
amputation pain, and current treatments, including total muscle reinnervation and regenerative peripheral nerve
interface, which are at the forefront of multidisciplinary treatment of lower extremity amputees.

Keywords: Lower extremity amputation, post-amputation pain, neuroma, targeted muscle reinnervation,
regenerative peripheral nerve interface

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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