Improving Quality of Life for Amputees Through Targeted Muscle Reinnervation Surgery

Ian Valerio, MD, MBA, is a Plastic and Reconstructive surgeon in the Department of Surgery at Massachusetts General Hospital. Here he discusses advances in targeted muscle reinnervation for the residual limb or amputee patient specifically, which has become a standard of care at Massachusetts General Hospital.

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Transcript

A lot of people ask me about what is targeted muscle reinnervation or TMR surgery as we call it. When we have a peripheral nerve that is amputated or cut, and it can't be reconstructed, we can find motor nerves within the surrounding muscles of the area where that peripheral nerve was injured, then hook them up, thereby allowing for a signal to go back so that nerve believes it's doing what it used to be doing so that it can innervate a distal target.

For the residual limb or amputee patient specifically, targeted muscle reinnervation has become a standard of care at Massachusetts General Hospital. We're doing targeted muscle reinnervation surgery at the time of their reputation, which through our research has shown a much greater reduction of phantom limb pain, prevention entirely of neuroma formation, especially symptomatic painful neuroma formation, and then also reduction of residual limb pain, which allows for them to get into their prosthetics earlier, more easily, improve quality life, as well as much reduction in their pain medicines that they require in order to actually recover from the reputation surgery.

If you look at the historical studies on amputations and pain, upwards of 85% of these patients who have suffered amputation have either neuroma, phantom and/or residual limb pain, but by doing this rather simple technique that we've perfected over time here at Massachusetts General Hospital, it has actually improved these patients' pain control to the point where they can better utilize their prosthetics, improve and reduce the amount of pain that they have as well as their pain narcotic, as well as other regimens, to the point where they're actually leading productive lives and getting back to society and actually functioning in a way that many had previously written off or did not think was possible. What we've seen in our ICAN clinic is a number these patients throughout the country and world that are flying here in order to be evaluated for ongoing neuropathic pain issues in their amputations, and they have been told by many people that there's not much that can be done for them and that's not true anymore and we know that.

There's been a number of exciting happenings here at Massachusetts General Hospital where we've determined new techniques and expanded targeted muscle reinnervation beyond the traditional amputation level some have considered to include not only partial hand, which is a new innovation that we have worked on here, as well as the traditional trans-radial or trans humeral amputations. We are also doing it for very proximal amputee patients such as four-quarter, both oncologic cancer as well as trauma patients, brachial plexus level TMR surgeries when appropriate, and then even lower extremity amputee patients such as partial foot as well as below-knee, above-knee and hip disarticulation patients, which we recently published on how we could do that as well for these patients.

So the amount of research that is ongoing in this area is improving, it's expanding here at Massachusetts General Hospital on our team and the ICAN team is specifically looking at other ways of that we can actually affect neuropathic pain not only in amputations now, but now expanding this to limb salvage and/or extremity injured patients to actually improve their outcomes beyond those that have lost their limbs as well.

We have actually collaborated with a number of regional players also in the prosthetist world that we can actually now collaborate with them to better access different type of novel as well as typical types of prosthetics that these patients may need for limb loss, recovery and restoration, and from that now this actually expands our ability to now collaborate not only within the Massachusetts General Hospital system but also throughout the region in order to improve health care for these patients that need it.

Learn about the Division of Plastic & Reconstructive Surgery

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