Targeted Muscle Reinnervation in the Hand for the Managment of Symptomatic Neuroma Following Digit and Hand Amputations

Ain Shams University

Status: Completed

Conditions: Neuroma; Targeted Muscle Reinervation; Digital Amputation

Treatments: Procedure: Targeted muscle reinnervation

Study type: Interventional

Funder types: Other

Identifiers

NCT06923566

FMASU MD 145/2021

Details and patient eligibility

About

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

Enrollment: 17 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Arabic or English speaking individuals
• An upper limb amputation distal to the wrist crease
• A symptomatic neuroma within the hand or digits: defined as patient-reported localized pain consistent with a clinical exam of a neuroma pain.There must be a supporting Tinel's sign on physical exam.

Exclusion criteria

• Cognitive impairment for better assessment of patient reported outcomes and filling questionnaires and signing consents

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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17 participants in 1 patient group

targeted muscle reinervation post digit amputation group

Experimental group

Description:

In 1ry TMR ,after the amputation is performed by the standard method , transected nerves will be replanted micro surgically to motor entry points (MEPS)in the hand as predetermined by Daugherty et al , Motor branches in the recipient muscles could be determined by a nerve stimulator intraoperatively. In 2ry TMR , neuroma site will be explored and it will be excised ,the distal end of the transected nerve will be connected micro surgically to the nearest MEPS

Treatment:

Procedure: Targeted muscle reinnervation