For patients with amputation, apart from having to go through and accept the impact of losing a limb either from trauma, tumor or peripheral vascular disease, many have to endure the continuous pain which feels like it is coming from the loss limb i.e., phantom limb pain. While the pain may vary in severity, its persistence can affect the working capacity and daily activities of the patients. As a result, many need to seek help from a pain specialist and/or a psychiatrist (for depression) and rely on different kinds of analgesics to carry on their daily lives.
Targeted muscle reinnervation (TMR) is a decade old surgical procedure designed to permit intuitive control of upper limb prostheses through a set of novel nerve transfers. It has been popularized in Europe and USA, mainly for the traumatic amputee. Yet by providing both a distal target and a vascularized scaffold on which to guide sprouting nerve axons, TMR has been noted that it can be a novel technique for the treatment of painful neuromas.
It has been observed that for patients who undergo TMR for prosthesis fitting, the prevalence of suffering from phantom limb pain is much less. Subsequent studies show that TMR can eliminate phantom limb pain in both acute setting and chronic setting. A randomized control trial also showed that a superior improvement in phantom limb pain in major amputees (both upper and lower limb amputees) can be achieved with TMR when compared with conventional surgical treatment
WE report our experience of performing TMR on patients who have suffer from phantom pain for many years as well as patients who need amputation acutely in Queen Mary Hospital. We report the tips and peals of doing TMR and highlight its pros and cons of performing TMR on acute and chronic patients.
