Daugherty Timothy H F, Parikh Rajiv, Mailey Brian A, Felder John M, Bueno Reuben A
Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo.
Plast Reconstr Surg Glob Open. 2020 Jul 16;8(7):e2990. doi: 10.1097/GOX.0000000000002990. eCollection 2020 Jul.
Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following below-knee amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.
靶向肌肉再支配术（TMR）有助于减轻膝下截肢（BKA）后的疼痛。虽然目前大多数文献描述了初次TMR背后的原理，但由于BKA通常由另一位外科医生进行，它们很少提供截肢关键的原理。当BKA和TMR由同一位外科医生进行时，可以通过两个手术所需的相同手术入路来完成。本文的目的是描述我们在计划初次TMR的情况下基于解剖学的BKA技术，该技术由2家机构的3位单中心周围神经整形外科医生实施。单外科医生技术的优点包括解剖效率高、保留供体神经长度、近端解剖有限、能早期识别用于吻合的受体运动神经、在止血带下仍能刺激这些神经以及减少止血带使用时间和手术时间。该技术快速、可靠且可重复，有助于在BKA时促进TMR的广泛应用。
