Targeted Muscle Reinnervation in the Hand for the Prevention and Treatment of Symptomatic Neuroma Following digit and Hand Amputations, A Prospective Case Series

Abstract

Abstract Background Neuromas are a common complication after digital and hand amputations, resulting in significant pain, discomfort, and functional impairment. Various management methods are available, including surgical excision, nerve blocks, and nerve stump protectors, but these treatments may have limited success rates and potential complications. Targeted muscle reinnervation (TMR) is a promising technique that involves surgically rerouting a severed nerve into a nearby muscle, which can prevent the formation of neuromas and provide improved muscle function. Aim of the Work The aim of this work is to assess the efficacy of Targeted muscle reinnervation in the treatment and prevention of symptomatic neuromas in digit and hand amputations, to evaluate the surgical technique and to record any possible postoperative complications or improvements of the technique in the hand. Materials and Methods We conducted a prospective case series at Ain Shams University hospitals, we recruited 20 patients eligible for our study by our criteria with digit or hand amputation distal to the wrist crease or a symptomatic neuroma within the hand or digits starting from August 2021 and for 24 months. We excluded patients with cognitive impairment for better outcomes assessment and patients below 18 years old. Either 1ry or 2ry TMR was performed on each patient. Results It has resulted in remarkable improvement in the neuroma pain experienced by our hand trauma patients and showed a promise as both a therapeutic and preventative tool to reduce the formation of symptomatic neuromas. Conclusion The technique requires good knowledge of hand microsurgical anatomy and good training in microsurgery, we observed a decrease in the operative time towards the conclusion of the study which proves the learning curve. TMR has minimal morbidity and is easily reproducible as demonstrated by multiple surgeons performing the surgery with consistent results.