From the Division of Plastic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2020 Nov;146(5):651e-663e. doi: 10.1097/PRS.0000000000007235.
After reading this article, the participants should be able to: 1. List current nonsurgical and surgical strategies for addressing postamputation neuroma pain and discuss their limitations. 2. Summarize the indications and rationale for targeted muscle reinnervation. 3. Develop an operative plan for targeted muscle reinnervation in an acute or delayed fashion for upper and lower extremity amputations. 4. Propose a management algorithm for treatment of symptomatic neuromas in an intact limb. 5. Discuss the risk of neuroma development after primary revision digital amputation or secondary surgery for a digital neuroma. 6. Compare and contrast targeted muscle reinnervation to the historical gold standard neuroma treatment of excision and burying the involved nerve in muscle, bone, or vein graft. 7. Interpret and discuss the evidence that targeted muscle reinnervation improves postamputation neuroma and phantom pain when performed either acutely or in a delayed fashion to treat existing pain.
Symptomatic injured nerves resulting from amputations, extremity trauma, or prior surgery are common and can decrease patient quality of life, thus necessitating an effective strategy for management. Targeted muscle reinnervation is a modern surgical strategy for prevention and treatment of neuroma pain that promotes nerve regeneration and healing rather than neuroma formation. Targeted muscle reinnervation involves the transfer of cut peripheral nerves to small motor nerves of adjacent, newly denervated segments of muscle and can be easily performed without specialized equipment. Targeted muscle reinnervation strategies exist for both upper and lower extremity amputations and for symptomatic neuromas of intact limbs. Targeted muscle reinnervation has been shown in a prospective, randomized, controlled trial to result in lower neuroma and phantom pain when compared to the historical gold standard of burying cut nerves in muscle.
阅读本文后，参与者应能够：1. 列出目前用于解决截肢后神经瘤疼痛的非手术和手术策略，并讨论其局限性。2. 总结靶向肌肉再支配的适应证和原理。3. 制定上肢和下肢截肢的急性或延迟靶向肌肉再支配的手术计划。4. 提出治疗完整肢体症状性神经瘤的管理算法。5. 讨论原发性修正数字截肢后或数字神经瘤的二次手术后神经瘤发展的风险。6. 将靶向肌肉再支配与切除受累神经并将其埋入肌肉、骨或静脉移植物的历史金标准神经瘤治疗进行比较和对比。7. 解释和讨论当以急性或延迟方式进行以治疗现有疼痛时，靶向肌肉再支配改善截肢后神经瘤和幻痛的证据。
截肢、肢体创伤或先前手术引起的有症状损伤神经很常见，会降低患者的生活质量，因此需要有效的管理策略。靶向肌肉再支配是一种预防和治疗神经瘤疼痛的现代手术策略，可促进神经再生和愈合，而不是形成神经瘤。靶向肌肉再支配涉及将切断的周围神经转移到相邻的、新去神经的肌肉小段的小运动神经，并且可以在没有专用设备的情况下轻松进行。针对上肢和下肢截肢以及完整肢体的症状性神经瘤都存在靶向肌肉再支配策略。前瞻性、随机、对照试验表明，与将切断的神经埋入肌肉的历史金标准相比，靶向肌肉再支配可导致神经瘤和幻痛降低。
