Chang Brian L, Kleiber Grant M
Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Plast Reconstr Surg Glob Open. 2023 Mar 27;11(3):e4663. doi: 10.1097/GOX.0000000000004663. eCollection 2023 Mar.
Postamputation pain from symptomatic neuromas and/or phantom limb pain can have a significant detrimental impact on patients' quality of life following a major lower extremity amputation. Various methods of physiologic nerve stabilization, such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface, have been proposed as the best current techniques to prevent that pathologic neuropathic pain.
This article details our institution's technique that has been performed safely and effectively on over 100 patients. Our approach and rationale for each of the major nerves of the lower extremity are presented.
In contrast to other described techniques for TMR for below-the-knee amputations, this current protocol does not involve performing transfers on all five major nerves, as one must balance rates of symptomatic neuroma formation and nerve-specific phantom limb pain with needed operative time and surgical morbidity from removing proximal sensory function and denervation of the donor motor nerve branches. This technique also differs significantly from others by performing a transposition of the superficial peroneal nerve to place the neurorrhaphy away from the weight-bearing stump.
This article details our institution's approach to physiologic nerve stabilization via TMR at time of below-the-knee amputation.
症状性神经瘤和/或幻肢痛引起的截肢后疼痛，会对下肢大截肢患者的生活质量产生重大不利影响。各种生理性神经稳定方法，如靶向肌肉再支配术（TMR）和再生周围神经接口，已被提议作为目前预防病理性神经病理性疼痛的最佳技术。
本文详细介绍了我们机构已在100多名患者身上安全有效实施的技术。介绍了我们对下肢各主要神经的处理方法及原理。
与其他已描述的膝下截肢TMR技术不同，本方案并不涉及对所有五条主要神经进行移位，因为必须在症状性神经瘤形成率和神经特异性幻肢痛与所需手术时间以及因去除近端感觉功能和供体运动神经分支去神经支配导致的手术并发症之间取得平衡。该技术还通过将腓浅神经移位以使神经缝合远离负重残端，与其他技术有显著差异。
本文详细介绍了我们机构在膝下截肢时通过TMR进行生理性神经稳定的方法。
