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Zargaran et al. Plast Aesthet Res 2023;10:10 Plastic and
DOI: 10.20517/2347-9264.2022.42
Aesthetic Research

Original Article Open Access

An analysis of the role of targeted muscle
reinnervation (TMR) in quality of life and pain

outcomes: a case series

David Zargaran, Raveenjot Nagra, Alexander Zargaran, Medha Akella, Yazan Ajam, Alex Woollard, Norbert
Kang

Department of Plastic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom.
Correspondence to: Dr. David Zargaran, Department of Plastic Surgery, Royal Free Hospital, Pond Street, London NW3 2QG,
United Kingdom. E-mail: d.zargaran@ucl.ac.uk

How to cite this article: Zargaran D, Nagra R, Zargaran A, Akella M, Ajam Y, Woollard A, Kang N. An analysis of the role of
targeted muscle reinnervation (TMR) in quality of life and pain outcomes: a case series. Plast Aesthet Res 2023;10:10.
https://dx.doi.org/10.20517/2347-9264.2022.42

Received: 26 Apr 2022 First Decision: 1 Aug 2022 Revised: 12 Dec 2022 Accepted: 15 Mar 2023 Published: 21 Mar 2023

Academic Editors: Jacques Henri Hacquebord, Harvey Chim Copy Editor: Ying Han Production Editor: Ying Han

Abstract
Aim: Targeted muscle reinnervation (TMR) surgery has fundamentally changed the management of patients who
have suffered or are about to undergo amputation. Providing nerve stumps with a muscle target has been shown to
have profound effects on levels of post-amputation pain in relation to phantom limb pain (PLP) and neuroma pain
(NP). The primary objective of this report was to quantify pain parameters for this population and to measure the
impact on health-related quality of life (HRQol) before and after TMR surgery. In this case series, we evaluate the
role of TMR in addressing both pain and the impact of the surgery on the patient’s quality of life.

Methods: A retrospective analysis of 15 upper limb amputee patients who underwent TMR by the Relimb Unit in
London, UK. Participants’ perceptions of pain were determined using the 11-point numerical (Pain) rating scale
(NRS) and HRQoL was calculated using the Euroqol EQ-5D-5L questionnaire at two time points, comparing both
pain and perceived quality of life pre and post surgery. The Wilcoxon Signed Rank Test was used for the NRS data
and a paired sample t-test was used for the EQ-VAS data.

Results: A total of 15 patients completed the evaluation. We observed statistically significant reductions in both
PLP (pre-operative mean: 7.6, post-operative mean: 2.7, P < 0.05) and NP (pre-operative mean: 6.4, post-operative
mean: 2.5, P < 0.05) in these patients. Similarly, HRQoL observed on the EQ-VAS scale demonstrated a significant

© The Author(s) 2023. 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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