Management of Unreconstructable Saphenous Nerve Injury with Targeted Muscle Reinnervation

• Published in: Plastic and reconstructive surgery. Global open Vol. 8; no. 1; p. e2383
• Main Authors: Janes, Lindsay E., Fracol, Megan E., Ko, Jason H., Dumanian, Gregory A.
• Format: Journal Article
• Language: English
• Published: United States The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons 01-01-2020; Copyright The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved; Wolters Kluwer Health; Wolters Kluwer
• Subjects: Ideas and Innovations
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000002383

Neuroma pain significantly impacts patient quality of life and is associated with unemployment, chronic opioid dependence, and depression. Targeted muscle reinnervation (TMR), a surgical technique that coapts proximal stumps of cut nerves to distal motor nerves of adjacent muscles, has demonstrated efficacy in the treatment and prevention of neuroma pain. The objective of this study was to describe the surgical technique for TMR of the saphenous nerve, while providing a retrospective review. Between January 2015 and December 2018, 18 patients underwent TMR of the saphenous nerve1 nonamputee patient with chronic pain after ankle surgery and 17 amputee patients (10 for relief of chronic postamputation neuroma pain and phantom pain and 7 at the time of amputation for prevention of these symptoms). Six patients were lost to follow up; 2 patients had recurrent pain; and 10 patients had reduced or no pain after TMR surgery. TMR is a successful technique for the management of traumatic neuroma pain in both the amputee and nonamputee populations, and in this study, we describe the technique for saphenous nerve TMR.