Savitz Benjamin L, Dean Yomna E, Myers Alake, Karagoz Huseyin, Hill J Bradford, Bhandari Panambur, Elmaraghi Shady, Lineaweaver William
Department of Plastic Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Microsurgery. 2025 May;45(4):e70061. doi: 10.1002/micr.70061.
In modern surgical practice, targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) offer amputees promising options for painful neuroma management, with the potential to significantly reduce pain and enhance prosthetic control. Despite these advancements, a lack of consensus on the standard of care persists, largely due to methodological inconsistencies in the current literature. Variations in control group selection, small sample sizes, and inadequate follow-up periods obstruct the reproducibility and generalizability of findings, complicating clinical decision-making. This critical review identifies key limitations in existing TMR studies, including biases introduced by heterogeneity in study design and an absence of direct comparisons between TMR and RPNI.
A systematic review was conducted following PRISMA guidelines to identify controlled TMR studies related to neuroma management. The data extracted included control group selection, sample size, TMR cohort size, and mean follow-up period.
Eleven studies evaluating TMR for neuroma management were analyzed. Control groups varied significantly, including amputation without reinnervation, neuroma excision, nerve burial, or preoperative pain assessments of participants. The heterogeneity in study design and small sample sizes limited further interpretation across studies. Moreover, only one randomized clinical trial was identified.
Recommendations are proposed for standardizing methodologies, implementing robust control groups, and prioritizing randomized controlled trials with extended follow-up periods. Bridging these gaps in future research can pave the way for evidence-based guidelines to improve patient outcomes in postamputation pain management.
