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Tanner et al. Plast Aesthet Res 2023;10:11 Plastic and
DOI: 10.20517/2347-9264.2022.95
Aesthetic Research

Review Open Access

The neurobiology of targeted muscle reinnervation
for post-amputation pain

1
Natalie Tanner , Omri Ayalon 2
1
Drexel University College of Medicine, Philadelphia, PA 19129, USA.
2
Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY 10010, USA.
Correspondence to: Dr. Omri Ayalon, Department of Orthopedic Surgery, NYU Langone Medical Center,130 Carroll St., Unit #2,
Brooklyn, NY 11231, USA. E-mail: omri.ayalon@nyulangone.org
How to cite this article: Tanner N, Ayalon O. The neurobiology of targeted muscle reinnervation for post-amputation pain. Plast
Aesthet Res 2023;10:11. https://dx.doi.org/10.20517/2347-9264.2022.95
Received: 19 Aug 2022 First Decision: 6 Mar 2023 Revised: 22 Mar 2023 Accepted: 28 Mar 2023 Published: 31 Mar 2023

Academic Editor: Harvey Chim Copy Editor: Ying Han Production Editor: Ying Han

Abstract
Targeted muscle reinnervation (TMR) is a peripheral nerve procedure that can prevent and treat postamputation
pain. The nerve transfer allows for organized nerve regeneration and repair after amputation surgery. The
procedure can successfully prevent neuromas despite large size mismatches between the donor and recipient
nerves. Here, we discuss the fundamentals of peripheral nerve injury and regeneration as it pertains to TMR. We
propose axonal pruning to explain axon behavior when there are large size mismatches between transferred
nerves. Given the increasing use of TMR for amputees, future studies should investigate the basic science of
peripheral nerves in TMR. Advances in this field have the potential to significantly improve clinical outcomes for
these patients.

Keywords: Targeted muscle reinnervation, peripheral nerve injury, nerve regeneration, axonal pruning

INTRODUCTION
More than 2 million amputees live in the United States, and approximately 185,000 amputations occur in
the United States each year . Pain is a significant problem affecting more than 70% of amputees .
[1]
[2]
Peripheral nerve injury and subsequent improper axon regeneration result in a disorganized bundle of
nerve tissue, known as a neuroma . Neuromas are a known cause of postamputation pain, which includes
[3]

© 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,
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