Page 31 - Read Online

Di Valerio et al. Plast Aesthet Res 2022;9:62 https://dx.doi.org/10.20517/2347-9264.2022.50 Page 5 of 10

(16), Primary Trans-radial (5) ● SBRN → Lateral head of triceps
● MABC nerve → Brachioradialis, FDP, ECRL
LABC nerve → ECRL, ECRB
● Median nerve → Short head of biceps
● Ulnar nerve → Brachialis
● Radial nerve → Lateral head of triceps
Transhumeral (5) ● Medial antebrachial cutaneous nerve → Brachialis
● Musculocutaneous nerve → Short head, long head
of biceps
● Musculocutaneous nerve → Clavicular head of
Shoulder disarticulation (6) pectoralis major
● Median nerve → Sternal head of pectoralis major
● Ulnar nerve → Sternal head of pectoralis major
● Radial nerve → Tibial nerve, latissimus dorsi

TMR: Targeted muscle reinnervation; SBRN: superficial branch of radial nerve; FCU: flexor carpi ulnaris; FDP: flexor digitorum profundus; FDS:
flexor digitorum superficialis; FPL: flexor pollicis longus; MABC: medial antebrachial cutaneous; LABC: lateral antebrachial cutaneous; ECRL:
extensor carpi radialis longus; ECRB: extensor carpi radialis brevis.

Table 2. PROMIS analysis - worst pain
First author, Worst pain at Worst pain at 1 Change from Worst pain at last Change from
year baseline year baseline follow-up baseline
Dumanian, PLP TMR 5.8 (SD 3.2) 2.6 (2.2) 3.2 (2.9) 2.3 (2.3) 3.5 (3.1)
2019 [7]
Standard 3.9 (SD 2.7) 4.1 (3.0) -0.2 (4.9) 4.4 (3.3) -0.5 (5.3)
RLP 6.6 (2.0) 3.7 (2.0) 2.9 (2.2) 3.6 (2.1 3.0 (2.1)
TMR
Standard 6.9 (2.5) 6.0 (2.5) 0.9 (3.3) 5.7 (3.0) 1.2 (3.5)
PLP: Phantom limb pain; RLP: residual limb pain; TMR: targeted muscle reinnervation; PROMIS: Patient Reported Outcome Measurement
Information System.

amputation for prevention of neuroma pain and postamputation pain, the 3 patients not lost to follow-up
(seen on average 6.67 months postoperatively) denied development of neuroma pain.

Additional studies reported outcomes for neuroma pain [15-19] . Kubiak et al reported postoperative outcomes
in a total of 90 patients, with 45 of these patients acting as controls and 45 undergoing TMR . 6 control
[16]
patients (13.3%) developed symptomatic neuromas in the postoperative period, compared with 0 patients in
the TMR group (P = 0.026). 23 TMR patients (51.1%) reported the development of PLP, compared with 41
control patients (91.1%; P < 0.0001) . Likewise, Morgan et al reported that among 3 patients undergoing
[16]
revision amputation with TMR for treatment of painful neuromas and 2 patients undergoing elective
[17]
amputation with concurrent TMR, all 5 patients reported improvement in pain . Although all 5 reported
improvements in pain, only 4 were able to use a prosthesis following the procedure. Souza et al. reported
that of 15 patients presenting with preexisting neuroma pain, 14 experienced complete resolution of pain
after TMR, with 1 patient having improvement of neuroma pain. No patients reported new-onset neuroma
pain following the TMR procedure . Pet 2014 analyzed 12 patients undergoing primary TMR for neuroma
[19]
prevention and 23 patients with established neuromas who underwent neuroma excision with secondary
TMR and reported that at follow-up, 11 of 12 patients (92%) after primary TMR and 20 of 23 patients (87%)
after secondary TMR were free of palpation-induced neuroma pain. Of the cohort undergoing primary
TMR, 6 out of 12 patients did develop PLP. For those undergoing secondary TMR, PLP was present in 8
patients before secondary TMR and in 8 patients afterward, showing persistent PLP in 7 patients with new
onset of phantom pain in 1 patient, and resolution of preoperative phantom pain in 1 patient .
[18]