Acute Versus Delayed Targeted Muscle Reinnervation for Upper-Extremity Amputations—Why Wait?

Background: While targeted muscle reinnervation (TMR) has been used for both prophylaxis and treatment of symptomatic neuromas after upper-extremity amputations, the impact of timing on outcomes after TMR remains unclear. We hypothesized that performing TMR acutely would improve pain and patient-reported outcomes compared to delayed TMR without an increased risk of complications. Methods: A single-center prospective registry was reviewed to identify patients with a history of TMR in the setting of transradial or transhumeral amputations. Patient demographics were reviewed, and patients with less than 3 months of follow-up were excluded. Acute TMR was defined as occurring within 30 days of the initial amputation, and delayed TMR as occurring beyond 30 days. Patient-reported outcomes and complications were reviewed. Results: Thirty-one limbs in 29 patients met inclusion criteria, with 21 limbs in the acute TMR group and 10 limbs in the delayed group. There were no differences in demographics or comorbidities between the two groups. The acute TMR group had lower final pain visual analog scale scores (1.6 vs 5.1, P = .001) and better Veterans-Rand 12-Item Health Survey (VR-12) mental component scores (31.5 vs 55.9, P = .011), with trends toward lower rates of depression. There was no difference in the postoperative complication rate between groups ( P = .99). Conclusions: Performing TMR acutely may improve long-term pain and mental health outcomes for upper-limb amputees. Acute TMR can be done safely without increasing the risk of complications.