Medical College of Wisconsin, Milwaukee, USA.
Clement J. Zablocki VA Medical Center Department of Plastic Surgery, Milwaukee, WI USA.
Hand (N Y). 2021 Nov;16(6):NP15-NP18. doi: 10.1177/1558944721992467. Epub 2021 Feb 17.
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.
靶向肌肉神经再支配（TMR）已被证明可改善急性和慢性截肢患者的幻肢痛和神经性疼痛。通过将主要外周神经重新连接到新去神经的肌肉，TMR利用了大脑的可塑性，有助于使感觉皮层恢复到损伤前的状态，从而有效减轻疼痛。我们重点介绍了一例因肉瘤行上臂截肢的独特病例，该患者最初接受了成功的肱骨 TMR 治疗。在 TMR 吻合部位进行了意外的神经活检后，他的疼痛复发，并且无法佩戴假肢。对他的 TMR 进行了更靠近近端的修正，从而改善了截肢手臂的疼痛和功能。这是首例强调同一肢体多次损伤时继发性神经可塑性和近端 TMR 修正成功的报告。
