scholarly journals Cautious Enthusiasm: The Role of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interface in the Treatment of Nerve-Related Amputation Pain

2021 ◽  
Vol 103 (8) ◽  
pp. e34
Author(s):  
Ann R. Schwentker
Keyword(s):  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Peripheral Nerve Interface

scholarly journals Der chirurgische Umgang mit peripheren Nerven nach Extremitätenverlust

2020 ◽  
Author(s):  
Clemens Gstoettner ◽  
Gregor Laengle ◽  
Stefan Salminger ◽  
Christopher Festin ◽  
Hannes Platzgummer ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Peripheral Nerve Interface

Zusammenfassung Hintergrund Nach Verlust einer Gliedmaße ist es die Aufgabe des Chirurgen, einen möglichst schmerzfreien und belastbaren Stumpf zu formen. Hierbei kommt insbesondere an der oberen Extremität ein funktioneller Aspekt hinzu, da zur Steuerung myoelektrischer Prothesen entsprechende Muskelsignale notwendig sind. Der Umgang mit peripheren Nerven im Stumpfbereich nimmt sowohl hinsichtlich der Schmerztherapie als auch der funktionellen Mensch-Maschinen-Anbindung eine zentrale Rolle ein. Ziel der Arbeit Die Darstellung aktueller chirurgischer Verfahren zum Umgang mit peripheren Nerven nach Extremitätenamputation. Material und Methoden Es erfolgt eine Literaturrecherche bzgl. chirurgischer Prophylaxe und Therapie von Neurom- und Phantomschmerzen, sowie zu Techniken zur Verbesserung der funktionellen Schnittstelle zwischen Stumpf und Prothese. Anhand relevanter Arbeiten sowie der Erfahrungen der Autoren werden entsprechende Empfehlungen formuliert. Ergebnisse und Diskussion Es gibt eine große Anzahl an verschiedenen Operationstechniken, insbesondere im Umgang mit schmerzhaften Neuromen. Von den klassischen Verfahren findet besonders häufig die intramuskuläre Verlagerung der endständiger Nerven Anwendung. Neuere Techniken wie Targeted Muscle Reinnervation (TMR) und Regenerative Peripheral Nerve Interface (RPNI) zielen erstmals darauf ab, dem Nerven auch nach Amputation funktionelle Endorgane zu liefern. Neben der verbesserten Steuerung myoelektrischer Prothesen zeigen diese Verfahren auch exzellente Ergebnisse in Bezug auf Neurom- und Phantomschmerzen.

scholarly journals Targeted Muscle Reinnervation Combined with a Vascularized Pedicled Regenerative Peripheral Nerve Interface

2020 ◽  
Vol 8 (3) ◽  
pp. e2689 ◽  
Author(s):  
Ian Valerio ◽  
Steven A. Schulz ◽  
Julie West ◽  
Ritsaart F. Westenberg ◽  
Kyle R. Eberlin
Keyword(s):  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Peripheral Nerve Interface

Current State of the Surgical Treatment of Terminal Neuromas

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 354-364 ◽  
Author(s):  
Graham C Ives ◽  
Theodore A Kung ◽  
Bao Tram Nghiem ◽  
Daniel C Ursu ◽  
David L Brown ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Peripheral Nerve ◽  
Targeted Muscle Reinnervation ◽  
Current State ◽  
Muscle Reinnervation ◽  
Pubmed Search ◽  
Patient Groups ◽  
Primary Focus ◽  
Neuroma Formation ◽  
Outcome Metrics

Abstract Painful terminal neuromas resulting from nerve injury following amputation are common. However, there is currently no universally accepted gold standard of treatment for this condition. A comprehensive literature review is presented on the treatment of terminal neuromas. Four categories of terminal neuroma surgical procedures are assessed: epineurial closure; nerve transposition with implantation; neurorrhaphy, and alternate target reinnervation. Significant patient and case studies are highlighted in each section, focusing on surgical technique and patient outcome metrics. Studies presented consisted of a PubMed search for “terminal neuromas,” without year limitation. The current available research supports the use of implantation into muscle for the surgical treatment of terminal neuromas. However, this technique has several fundamental flaws that limit its utility, as it does not address the underlying physiology behind neuroma formation. Regenerative peripheral nerve interfaces and targeted muscle reinnervation are 2 techniques that seem to offer the most promise in preventing and treating terminal neuroma formation. Both techniques are also capable of generating control signals which can be used for both motor and sensory prosthetic control. Such technology has the potential to lead to the future restoration of lost limb function in amputees. Further clinical research employing larger patient groups with high-quality control groups and reproducible outcome measures is needed to determine the most effective and beneficial surgical treatment for terminal neuromas. Primary focus should be placed on investigating techniques that most closely approximate the theoretically ideal neuroma treatment, including targeted muscle reinnervation and regenerative peripheral nerve interfaces.

Surgical and technological advances in the management of upper limb amputees

2021 ◽  
Vol 103-B (3) ◽  
pp. 430-439
Author(s):  
Michael Geary ◽  
Raymond Glenn Gaston ◽  
Bryan Loeffler
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Technological Development ◽  
Surgical Techniques ◽  
Paradigm Shifts ◽  
Myoelectric Signal ◽  
Targeted Muscle Reinnervation ◽  
Technological Advances ◽  
Peripheral Nerve Interface ◽  
Near Future

Upper limb amputations, ranging from transhumeral to partial hand, can be devastating for patients, their families, and society. Modern paradigm shifts have focused on reconstructive options after upper extremity limb loss, rather than considering the amputation an ablative procedure. Surgical advancements such as targeted muscle reinnervation and regenerative peripheral nerve interface, in combination with technological development of modern prosthetics, have expanded options for patients after amputation. In the near future, advances such as osseointegration, implantable myoelectric sensors, and implantable nerve cuffs may become more widely used and may expand the options for prosthetic integration, myoelectric signal detection, and restoration of sensation. This review summarizes the current advancements in surgical techniques and prosthetics for upper limb amputees. Cite this article: Bone Joint J 2021;103-B(3):430–439.

Role of Peripheral Nerve-Derived Fibroblasts and Schwann Cells in CD40/CD40L and CD80/CD86-Mediated Rejection

2006 ◽  
Vol 22 (06) ◽  
Author(s):  
Deborah Yu ◽  
Sherri Wood ◽  
Keri Smith ◽  
Keith Bishop ◽  
Paul Cederna
Keyword(s):  
Peripheral Nerve ◽  
Schwann Cells

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report

Hand ◽  
2021 ◽  
pp. 155894472199246
Author(s):  
David D. Rivedal ◽  
Meng Guo ◽  
James Sanger ◽  
Aaron Morgan
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerves ◽  
Nerve Biopsy ◽  
Sensory Cortex ◽  
Denervated Muscle ◽  
Unique Case ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
And Function ◽  
The Brain

Targeted muscle reinnervation (TMR) has been shown to improve phantom and neuropathic pain in both the acute and chronic amputee population. Through rerouting of major peripheral nerves into a newly denervated muscle, TMR harnesses the plasticity of the brain, helping to revert the sensory cortex back toward the preinsult state, effectively reducing pain. We highlight a unique case of an above-elbow amputee for sarcoma who was initially treated with successful transhumeral TMR. Following inadvertent nerve biopsy of a TMR coaptation site, his pain returned, and he was unable to don his prosthetic. Revision of his TMR to a more proximal level was performed, providing improved pain and function of the amputated arm. This is the first report to highlight the concept of secondary neuroplasticity and successful proximal TMR revision in the setting of multiple insults to the same extremity.

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