Outcomes, challenges and pitfalls after targeted muscle reinnervation in high level amputees. Is it worth the effort?

Stefan Salminger, Agnes Sturma, Aidan D Roche, Johannes A Mayer, Clemens Gstoettner, Oskar C Aszmann

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Although the distal targets have been lost in proximal upper-limb amputees, the neural signals for intuitive hand and arm function are still available and thus can be incorporated into more useful prosthetic function using Targeted Muscle Reinnervation (TMR) technique. Here we present our outcomes and range of indications as well as experiences and pitfalls after 30 TMR cases at above-elbow- and shoulder-disarticulation level of amputation.

METHODS: 30 patients with above-elbow or shoulder-disarticulation amputations were enrolled between 2012 and 2017. Indications for TMR surgery differed between improvement of prosthetic function (n=19) and/or pain (n=11). Functional outcome was evaluated with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Clothepin-Relocation Test (CPRT). Functional evaluation was performed at least at six months after final prosthetic fitting.

RESULTS: All nerve transfers were successful and provided independent myoelectric signals. The 10 patients available for final functional evaluation showed ARAT scores of 20.4 ± 1.9 and SHAP scores of 40.5 ± 8.1. The CPRT showed a mean time of 34.3 ± 14.4 seconds.

CONCULSIONS: TMR has improved prosthetic control and revolutionized neuroma treatment in upper limb amputees. Still, the rate of abandonment even after TMR surgery has been shown high and it will need several advances within the biotechnological interface to improve prosthetic function and acceptance in these patients.

Original languageEnglish
JournalPlastic and reconstructive surgery
Early online date27 Aug 2019
DOIs
Publication statusE-pub ahead of print - 27 Aug 2019

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