News Release

Early nerve intervention reduces pain and complications after amputation

Targeted muscle reinnervation decreases phantom and residual limb pain, reports Plastic and Reconstructive Surgery®

Peer-Reviewed Publication

Wolters Kluwer Health

Waltham — January 4, 2024 —Performed early – at the time of amputation – a procedure called targeted muscle reinnervation (TMR) can reduce pain scores and prevent complications related to abnormal nerve regrowth, suggests a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer

"Our experience suggests that that acute TMR reduces neuroma formation, and lowers the incidence of both phantom limb pain and residual limb pain," comments senior author Amy M. Moore, MD, of Ohio State University Wexner Medical Center, Columbus. 

Acute versus delayed TMR: Five-year experience supports early nerve intervention 

Patients undergoing amputation are at risk of certain types of chronic pain problems. They may experience phantom limb pain, a sensation of pain in the missing limb; or residual limb pain, felt in the remaining portion (stump) of the amputated limb. For patients who suffer from one or both types of post-amputation pain, the effects on their quality of life are significant. 

Targeted muscle reinnervation is a surgical procedure in which the cut nerve is transferred, i.e., "re-wired" to a working nerve in an adjacent muscle. First developed to enhance control of prostheses after amputation, TMR may also help to decrease phantom and residual limb pain after amputation. However, there are continued questions about the effects of the timing of TMR: acute or early, performed at the time of amputation; or delayed, performed after the development of a symptomatic neuroma. 

Dr. Moore and colleagues reviewed their experience with TMR in 103 patients (105 limbs) undergoing amputation. In 73 limbs, acute TMR was performed at the time of amputation. In 32 limbs, TMR was delayed, performed after development of a symptomatic neuroma – i.e., scarring and disorganized regrowth of cut nerves. 

Lower pain scores, lower neuroma risk after acute TMR 

Comparison suggested improved outcomes in the immediate TMR group. Just one percent of patients undergoing acute TMR had recurrent, symptomatic neuromas in the area served by the reconnected nerve, compared to 19 percent in the delayed TMR group. The difference remained significant after adjustment for other characteristics (age, sex, and limb involved). Neuroma risk in other nerve distributions was unaffected by the timing of TMR. 

Patient-reported pain scores were available for 62 limbs in the acute TMR group and 20 in the delayed TMR group. Patients undergoing acute TMR had lower pain intensity and severity scores, as well as lower scores for pain interference with daily activities. 

The findings add to previous promising results for TMR in improving post-amputation outcomes. The researchers note that the observed 1.4% neuroma rate in the acute TMR group is lower than reported in previous studies, supporting "the effectiveness of early intervention with TMR." They add: "[E]arly restoration of the physiologic function of nerves treated by TMR in the acute amputation setting may prevent those nerves from aberrantly regenerating in the absence of TMR." 

While early TMR may have advantages, the experience also demonstrates beneficial effects of delayed TMR for patients with phantom or residual limb pain after amputation. In both groups, "the percentage of patients reporting no pain is nearly two times higher than the general amputee population," the researchers add. 

While acknowledging the limitations of their single-center, non-randomized study, Dr. Moore and coauthors conclude: "The results further highlight the promising role of TMR in the prevention of neuropathic pain and neuroma formation when performed at the time of amputation and reinforce what we know about TMR as an effective procedure to treat symptomatic post-amputation pain." 

Read Article [ Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation ] 

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About Plastic and Reconstructive Surgery 

For over 75 years, Plastic and Reconstructive Surgery® ( has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues. 

About ASPS 

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. 

About Wolters Kluwer 

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.  

Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,900 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. 

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