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Di Valerio et al. Plast Aesthet Res 2022;9:62 Plastic and
DOI: 10.20517/2347-9264.2022.50
Aesthetic Research

Systematic Review Open Access

Efficacy of targeted muscle reinnervation for treating
and preventing postamputation pain - a systematic

review

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Elizabeth Di Valerio , Lauren Lautenslager , Peter Vonu , Chopan Mustafa , Harvey Chim , Ellen Satteson 1
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Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL 32610, USA.
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Division of Plastic Surgery, Indiana University School of Medicine, Gainesville, FL 32610, USA.
Correspondence to: Dr. Elizabeth Di Valerio, Division of Plastic and Reconstructive Surgery, University of Florida, Gainesville, FL
32610, USA. E-mail: edivalerio@ufl.edu
How to cite this article: Di Valerio E, Lautenslager L, Vonu P, Mustafa C, Chim H, Satteson E. Efficacy of targeted muscle
reinnervation for treating and preventing postamputation pain - a systematic review. Plast Aesthet Res 2022;9:62.
https://dx.doi.org/10.20517/2347-9264.2022.50
Received: 25 May 2022 First Decision: 15 Aug 2022 Revised: 28 Aug 2022 Accepted: 22 Dec 2022 Published: 28 Dec 2022

Academic Editors: Jacques Henri Hacquebord, Pierluigi Tos Copy Editor: Ying Han Production Editor: Ying Han

Abstract
Aim: Targeted muscle reinnervation (TMR) is a procedure pioneered to improve control of myoelectric prostheses
and was fortuitously found to improve postamputation pain by transferring residual nerve ends from an amputated
limb to reinnervate motor nerve units in denervated muscles. This study sought to perform a systematic review of
the literature regarding the postamputation pain-related outcomes following TMR.

Methods: PubMed database was queried using the key term “targeted muscle reinnervation”. Articles were chosen
based on the following criteria: (1) clinical studies on TMR; (2) greater than one subject; (3) studies were case-
controls, comparative cohort analyses, controlled trials, or randomized controlled trials; and (4) studies included
one or more outcomes of interest: prosthetic use and functionality, improvement or persistence of pain, indications,
complications, donor nerves, and technical aspects of TMR.

Results: Overall, 9 studies including 101 upper extremity and 252 lower extremity nerve transfers were analyzed,
with nerve transfer type, amputation location, and specific neurotizations reported. Four studies assessed the
efficacy of TMR in addressing phantom limb pain (PLP) and residual limb pain (RLP), with 3 out of 4 studies
reporting significant improvements in PROMIS (Patient Reported Outcome Measurement Information System)
scores in TMR subjects compared to controls. Five additional studies did not analyze PROMIS scores but reported
subjective improvements in pain outcomes.

© 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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