Targeted muscle reinnervation for treatment of painful stump neuroma_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIONG Debin ¹ , Aierbanjiang·Shali ¹ , Xiriaili·Kadier ¹ , CHENG Erlin ^1,2 , Yiliyaer·Wumaierjiang ¹ , Abudoukelimu·Abudouxiku ¹ ,  Aihemaitijiang·Yusufu ^1,2

1. Department of Microsurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830011, P. R. China;
2. Xinjiang Key Laboratory of Trauma Repair and Reconstruction, Urumqi Xinjiang, 830011, P. R. China;

Corresponding?author：

Aihemaitijiang·Yusufu, Email: ahmatjang@163.com

Keywords：

Targeted muscle reinnervation; painful stump neuroma; small gap anastomosis; epineurial sheath tube; pain; post-amputation

DOI：

10.7507/1002-1892.202601115

Video：

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Objective To investigate the effectiveness of incorporating small gap anastomosis (SGA) and epineurial sheath tube (EST) sleeve coaptation into conventional targeted muscle reinnervation (TMR) for the treatment of post-amputation painful stump neuroma (PSN), and to compare the outcomes between different types of nerves undergoing coaptation, namely sensory nerves and mixed nerves. Methods The clinical data of 30 patients with PSN who underwent TMR combined with SGA and EST sleeve coaptation between January 2020 and January 2025 were retrospectively analyzed. According to the type of nerve undergoing coaptation, the patients were divided into a sensory nerve coaptation group (group A, 13 cases) and a mixed nerve coaptation group (group B, 17 cases). There was no significant difference between the two groups in age, gender, amputation site, cause of amputation, or preoperative visual analogue scale (VAS) pain score (P>0.05). However, the preoperative numerical rating scale (NRS) score was significantly higher in group A than in group B (P<0.05). Postoperative pain relief was evaluated using the NRS and VAS scores. At last follow-up, high-frequency ultrasonography was performed to assess the morphology of the nerve coaptation site, blood flow signals, and recurrence of PSN. Results All patients in both groups were followed up, the follow-up time was (11.38±1.34) months in group A and (11.71±1.60) months in group B, with no significant difference between the two groups (t=?0.583, P=0.564). In both groups, the VAS and NRS scores before discharge and at last follow-up improved when compared with the preoperative scores, and further improvement was observed over time after surgery; all differences were significant (P<0.05). There was no significant difference between the two groups in the VAS or NRS scores before discharge, or in the NRS score at last follow-up (P>0.05). However, at last follow-up, the VAS score was significantly lower in group A than in group B (P<0.05). At last follow-up, PSN recurrence occurred in 1 patient in group A, with an NRS score of 2. In group B, high-frequency ultrasonography revealed hypoechoic nodular thickening at the original nerve coaptation site, sparse blood flow signals, and an increased cross-sectional area compared with the proximal segment of the same nerve in 3 patients, suggesting neuroma-like changes; however, none of these patients had residual limb pain. No PSN recurrence was detected in the remaining patients. Postoperatively, 1 patient in group A developed paresthesia around the surgical incision, and 3 patients in group B experienced delayed incision healing. Twenty-two patients were successfully fitted with prostheses. Conclusion TMR combined with SGA and EST sleeve coaptation can relieve pain to some extent in the treatment of post-amputation PSN. TMR targeting sensory nerves may show a trend toward better pain control; however, further validation is still required.

Citation： XIONG Debin, Aierbanjiang·Shali, Xiriaili·Kadier, CHENG Erlin, Yiliyaer·Wumaierjiang, Abudoukelimu·Abudouxiku, Aihemaitijiang·Yusufu. Targeted muscle reinnervation for treatment of painful stump neuroma. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 949-957. doi: 10.7507/1002-1892.202601115 Copy

1.	Chang BL, Mondshine J, Fleury CM, et al. Incidence and nerve distribution of symptomatic neuromas and phantom limb pain after below-knee amputation. Plast Reconstr Surg, 2022, 149(4): 976-985.
2.	幻肢痛診斷與治療中國疼痛科專家共識編寫組, 蔣宗濱, 岳侃, 等. 幻肢痛診斷與治療中國疼痛科專家共識 (2024版). 中華疼痛學雜志, 2024, 20(2): 164-178.
3.	Rasuli? L, Lepi? M, Shlobin N, et al. A brief history of peripheral nerve surgery in serbia. World Neurosurg, 2023, 171: 88-93.
4.	Hill EJR, Patterson JMM, Yee A, et al. What is operative? Conceptualizing neuralgia: Neuroma, compression neuropathy, painful hyperalgesia, and phantom nerve pain. J Hand Surg Glob Online, 2022, 5(1): 126-132.
5.	Tong SH, Liu DL, Liao P, et al. Emerging role of macrophages in neuropathic pain. J Orthop Translat, 2025, 51: 227-241.
6.	Yang H, Dong Y, Wang Z, et al. Traumatic neuromas of peripheral nerves: Diagnosis, management and future perspectives. Front Neurol, 2023, 13: 1039529. doi: 10.3389/fneur.2022.1039529.
7.	Chou J, Liston JM, DeGeorge BR. Traditional neuroma management strategies: A systematic review. Ann Plast Surg, 2023, 90(6S Suppl 4): S350-S355.
8.	Kuiken TA, Dumanian GA, Lipschutz RD, et al. The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee. Prosthet Orthot Int, 2004, 28(3): 245-253.
9.	Simon AM, Turner KL, Miller LA, et al. Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation. PLoS One, 2023, 18(1): e0280210. doi: 10.1371/journal.pone.0280210.
10.	Bishay J, Yeap I, Wang T. The effectiveness of targeted muscle reinnervation in reducing pain and improving quality of life for patients following lower limb amputation. J Plast Reconstr Aesthet Surg, 2024, 92: 288-298.
11.	Tendijck GAH, van Schaik J, Dijkman RR, et al. Prevention of postamputation pain with targeted muscle reinnervation (PreventPAP trial): protocol for a national, multicentre, randomised, sham-controlled trial. BMJ Open, 2025, 15(11): e105053. doi: 10.1136/bmjopen-2025-105053.
12.	Raasveld FV, Mayrhofer-Schmid M, Johnston BR, et al. Targeted muscle reinnervation at the time of amputation to prevent the development of neuropathic pain. J Plast Reconstr Aesthet Surg, 2024, 97: 13-22.
13.	Pettersen E, Sassu P, Pedrini FA, et al. Targeted muscle reinnervation: Surgical protocol for a randomized controlled trial in postamputation pain. J Vis Exp, 2024, (205). doi: 10.3791/66379.
14.	Hagiga A, Aly M, Gumaa M, et al. Targeted muscle reinnervation in managing post-amputation related pain: A systematic review and meta-analysis. Pain Pract, 2023, 23(8): 922-932.
15.	Chang BL, Mondshine J, Attinger CE, et al. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg, 2021, 148(2): 376-386.
16.	Crosio A, Rosanda E, Latini F, et al. The recurrence of painful neuromas of the limbs following TMR. J Clin Med, 2025, 14(4): 1078. doi: 10.3390/jcm14041078.
17.	Felder JM, Pripotnev S, Ducic I, et al. Failed targeted muscle reinnervation: findings at revision surgery and concepts for success. Plast Reconstr Surg Glob Open, 2022, 10(4): e4229. doi: 10.1097/GOX.0000000000004229.
18.	Goodyear EG, O’Brien AL, West JM, et al. Targeted muscle reinnervation at the time of amputation decreases recurrent symptomatic neuroma formation. Plast Reconstr Surg, 2024, 153(1): 154-163.
19.	Muheremu A, Wang Y, Peng J. Advances in experimental and clinical studies of chemotaxis. Can J Neurol Sci, 2013, 40(3): 292-298.
20.	Thomson SE, Ng NY, Riehle MO, et al. Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb. Cochrane Database Syst Rev, 2022, 12(12): CD012574. doi: 10.1002/14651858.CD012574.pub2.
21.	Finkelstein ER, Hui-Chou H, Fullerton N, et al. Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation. Skeletal Radiol, 2024, 53(4): 811-816.
22.	Feng JY, Xu WB, You WJ, et al. Compare the clinical value of two minimally invasive approaches to locating radial nerve in the posterior humeral approach. BMC Musculoskelet Disord, 2023, 24(1): 188. doi: 10.1186/s12891-023-06291-3.
23.	李晨, 浦少鋒, 吳軍珍, 等. 超聲引導下殘端神經瘤毀損治療截肢后疼痛回顧性分析. 中國疼痛醫學雜志, 2022, 28(1): 36-43.
24.	Scott BB, Winograd JM, Redmond RW. Surgical approaches for prevention of neuroma at time of peripheral nerve injury. Front Surg, 2022, 9: 819608. doi: 10.3389/fsurg.2022.819608.
25.	Hespe GE, Brown DL. Management of neuropathic pain with neurectomy combined with dermal sensory regenerative peripheral nerve interface (DS-RPNI). Semin Plast Surg, 2024, 38(1): 48-52.
26.	Valerio IL, Dumanian GA, Jordan SW, et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg, 2019, 228(3): 217-226.
27.	郭耀, 趙巍, 黃劍平, 等. 智能假肢的人機接口構建技術——靶向肌肉神經功能重建. 中國修復重建外科雜志, 2023, 37(8): 1021-1025.
28.	鄧永蘭, 張苡榕, 唐春霄, 等. 靶向神經分布重建技術研究進展. 中國臨床解剖學雜志, 2023, 41(3): 371-374.
29.	Chappell AG, Ramsey MD, Park S, et al. Targeted muscle reinnervation-an up-to-date review: Evidence, indications, and technique. Arch Plast Surg, 2025, 52(3): 153-168.
30.	Mauch JT, Kao DS, Friedly JL, et al. Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review. PM R, 2023, 15(11): 1457-1465.
31.	ElAbd R, Dow T, Jabori S, et al. Pain and functional outcomes following targeted muscle reinnervation: A systematic review. Plast Reconstr Surg, 2024, 153(2): 494-508.
32.	Ferrin PC, Hathaway B, Russo SA, et al. Use of supinator motor branches in targeted muscle reinnervation of the superficial radial nerve. Plast Reconstr Surg Glob Open, 2024, 12(1): e5512. doi: 10.1097/GOX.0000000000005512.
33.	Harnoncourt L, Schmoll M, Festin C, et al. Axonal regeneration and innervation ratio following supercharged end-to-side nerve transfer. Front Cell Dev Biol, 2025, 13: 1513321. doi: 10.3389/fcell.2025.1513321.
34.	Corder BN, Lebhar MS, Arnold P, et al. Targeted muscle reinnervation: a brief history of a promising procedure for effective management of amputation pain. Wounds, 2023, 35(12): E433-E438.
35.	Richards JT, Baird MD, Tintle SM, et al. Peripheral nerve management in extremity amputations. Orthop Clin North Am, 2022, 53(2): 155-166.
36.	Singh KK, Park KJ, Hong EJ, et al. Developmental axon pruning mediated by BDNF-p75NTR-dependent axon degeneration. Nat Neurosci, 2008, 11(6): 649-658.
37.	Wang P, Zhao J, Jiang B, et al. Use of small gap anastomosis for the repair of peripheral nerve injury by cutting and sleeve jointing the epineurium. J Reconstr Microsurg, 2015, 31(4): 268-276.
38.	Peixun Z, Na H, Kou Y, et al. Peripheral nerve intersectional repair by bi-directional induction and systematic remodelling: biodegradable conduit tubulization from basic research to clinical application. Artif Cells Nanomed Biotechnol, 2017, 45(8): 1464-1466.
39.	Wang S, Yang X, Liu K, et al. Therapeutic potential of omaveloxolone in counteracting muscle atrophy post-denervation: a multi-omics approach. J Transl Med, 2024, 22(1): 991. doi: 10.1186/s12967-024-05810-7.
40.	Liu Z, Liu Y, Yushan M, et al. Enhanced nerve regeneration by bionic conductive nerve scaffold under electrical stimulation. Front Neurosci, 2022, 16: 810676. doi: 10.3389/fnins.2022.810676.
41.	Li T, Cheng Q, Zhang J, et al. A novel flexible nerve guidance conduit promotes nerve regeneration while providing excellent mechanical properties. Neural Regen Res, 2025, 20(7): 2084-2094.
42.	Kenji K, Hasegawa H, Omokawa S, et al. Anatomical study of vulnerable sensory and expendable motor nerves for targeted muscle reinnervation in the upper extremity. J Plast Surg Hand Surg, 2025, 60: 35-39.
43.	Adidharma W, Khouri AN, Lee JC, et al. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve, 2022, 66(4): 384-396.

1. Chang BL, Mondshine J, Fleury CM, et al. Incidence and nerve distribution of symptomatic neuromas and phantom limb pain after below-knee amputation. Plast Reconstr Surg, 2022, 149(4): 976-985.
2. 幻肢痛診斷與治療中國疼痛科專家共識編寫組, 蔣宗濱, 岳侃, 等. 幻肢痛診斷與治療中國疼痛科專家共識 (2024版). 中華疼痛學雜志, 2024, 20(2): 164-178.
3. Rasuli? L, Lepi? M, Shlobin N, et al. A brief history of peripheral nerve surgery in serbia. World Neurosurg, 2023, 171: 88-93.
4. Hill EJR, Patterson JMM, Yee A, et al. What is operative? Conceptualizing neuralgia: Neuroma, compression neuropathy, painful hyperalgesia, and phantom nerve pain. J Hand Surg Glob Online, 2022, 5(1): 126-132.
5. Tong SH, Liu DL, Liao P, et al. Emerging role of macrophages in neuropathic pain. J Orthop Translat, 2025, 51: 227-241.
6. Yang H, Dong Y, Wang Z, et al. Traumatic neuromas of peripheral nerves: Diagnosis, management and future perspectives. Front Neurol, 2023, 13: 1039529. doi: 10.3389/fneur.2022.1039529.
7. Chou J, Liston JM, DeGeorge BR. Traditional neuroma management strategies: A systematic review. Ann Plast Surg, 2023, 90(6S Suppl 4): S350-S355.
8. Kuiken TA, Dumanian GA, Lipschutz RD, et al. The use of targeted muscle reinnervation for improved myoelectric prosthesis control in a bilateral shoulder disarticulation amputee. Prosthet Orthot Int, 2004, 28(3): 245-253.
9. Simon AM, Turner KL, Miller LA, et al. Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation. PLoS One, 2023, 18(1): e0280210. doi: 10.1371/journal.pone.0280210.
10. Bishay J, Yeap I, Wang T. The effectiveness of targeted muscle reinnervation in reducing pain and improving quality of life for patients following lower limb amputation. J Plast Reconstr Aesthet Surg, 2024, 92: 288-298.
11. Tendijck GAH, van Schaik J, Dijkman RR, et al. Prevention of postamputation pain with targeted muscle reinnervation (PreventPAP trial): protocol for a national, multicentre, randomised, sham-controlled trial. BMJ Open, 2025, 15(11): e105053. doi: 10.1136/bmjopen-2025-105053.
12. Raasveld FV, Mayrhofer-Schmid M, Johnston BR, et al. Targeted muscle reinnervation at the time of amputation to prevent the development of neuropathic pain. J Plast Reconstr Aesthet Surg, 2024, 97: 13-22.
13. Pettersen E, Sassu P, Pedrini FA, et al. Targeted muscle reinnervation: Surgical protocol for a randomized controlled trial in postamputation pain. J Vis Exp, 2024, (205). doi: 10.3791/66379.
14. Hagiga A, Aly M, Gumaa M, et al. Targeted muscle reinnervation in managing post-amputation related pain: A systematic review and meta-analysis. Pain Pract, 2023, 23(8): 922-932.
15. Chang BL, Mondshine J, Attinger CE, et al. Targeted muscle reinnervation improves pain and ambulation outcomes in highly comorbid amputees. Plast Reconstr Surg, 2021, 148(2): 376-386.
16. Crosio A, Rosanda E, Latini F, et al. The recurrence of painful neuromas of the limbs following TMR. J Clin Med, 2025, 14(4): 1078. doi: 10.3390/jcm14041078.
17. Felder JM, Pripotnev S, Ducic I, et al. Failed targeted muscle reinnervation: findings at revision surgery and concepts for success. Plast Reconstr Surg Glob Open, 2022, 10(4): e4229. doi: 10.1097/GOX.0000000000004229.
18. Goodyear EG, O’Brien AL, West JM, et al. Targeted muscle reinnervation at the time of amputation decreases recurrent symptomatic neuroma formation. Plast Reconstr Surg, 2024, 153(1): 154-163.
19. Muheremu A, Wang Y, Peng J. Advances in experimental and clinical studies of chemotaxis. Can J Neurol Sci, 2013, 40(3): 292-298.
20. Thomson SE, Ng NY, Riehle MO, et al. Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb. Cochrane Database Syst Rev, 2022, 12(12): CD012574. doi: 10.1002/14651858.CD012574.pub2.
21. Finkelstein ER, Hui-Chou H, Fullerton N, et al. Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation. Skeletal Radiol, 2024, 53(4): 811-816.
22. Feng JY, Xu WB, You WJ, et al. Compare the clinical value of two minimally invasive approaches to locating radial nerve in the posterior humeral approach. BMC Musculoskelet Disord, 2023, 24(1): 188. doi: 10.1186/s12891-023-06291-3.
23. 李晨, 浦少鋒, 吳軍珍, 等. 超聲引導下殘端神經瘤毀損治療截肢后疼痛回顧性分析. 中國疼痛醫學雜志, 2022, 28(1): 36-43.
24. Scott BB, Winograd JM, Redmond RW. Surgical approaches for prevention of neuroma at time of peripheral nerve injury. Front Surg, 2022, 9: 819608. doi: 10.3389/fsurg.2022.819608.
25. Hespe GE, Brown DL. Management of neuropathic pain with neurectomy combined with dermal sensory regenerative peripheral nerve interface (DS-RPNI). Semin Plast Surg, 2024, 38(1): 48-52.
26. Valerio IL, Dumanian GA, Jordan SW, et al. Preemptive treatment of phantom and residual limb pain with targeted muscle reinnervation at the time of major limb amputation. J Am Coll Surg, 2019, 228(3): 217-226.
27. 郭耀, 趙巍, 黃劍平, 等. 智能假肢的人機接口構建技術——靶向肌肉神經功能重建. 中國修復重建外科雜志, 2023, 37(8): 1021-1025.
28. 鄧永蘭, 張苡榕, 唐春霄, 等. 靶向神經分布重建技術研究進展. 中國臨床解剖學雜志, 2023, 41(3): 371-374.
29. Chappell AG, Ramsey MD, Park S, et al. Targeted muscle reinnervation-an up-to-date review: Evidence, indications, and technique. Arch Plast Surg, 2025, 52(3): 153-168.
30. Mauch JT, Kao DS, Friedly JL, et al. Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic review. PM R, 2023, 15(11): 1457-1465.
31. ElAbd R, Dow T, Jabori S, et al. Pain and functional outcomes following targeted muscle reinnervation: A systematic review. Plast Reconstr Surg, 2024, 153(2): 494-508.
32. Ferrin PC, Hathaway B, Russo SA, et al. Use of supinator motor branches in targeted muscle reinnervation of the superficial radial nerve. Plast Reconstr Surg Glob Open, 2024, 12(1): e5512. doi: 10.1097/GOX.0000000000005512.
33. Harnoncourt L, Schmoll M, Festin C, et al. Axonal regeneration and innervation ratio following supercharged end-to-side nerve transfer. Front Cell Dev Biol, 2025, 13: 1513321. doi: 10.3389/fcell.2025.1513321.
34. Corder BN, Lebhar MS, Arnold P, et al. Targeted muscle reinnervation: a brief history of a promising procedure for effective management of amputation pain. Wounds, 2023, 35(12): E433-E438.
35. Richards JT, Baird MD, Tintle SM, et al. Peripheral nerve management in extremity amputations. Orthop Clin North Am, 2022, 53(2): 155-166.
36. Singh KK, Park KJ, Hong EJ, et al. Developmental axon pruning mediated by BDNF-p75NTR-dependent axon degeneration. Nat Neurosci, 2008, 11(6): 649-658.
37. Wang P, Zhao J, Jiang B, et al. Use of small gap anastomosis for the repair of peripheral nerve injury by cutting and sleeve jointing the epineurium. J Reconstr Microsurg, 2015, 31(4): 268-276.
38. Peixun Z, Na H, Kou Y, et al. Peripheral nerve intersectional repair by bi-directional induction and systematic remodelling: biodegradable conduit tubulization from basic research to clinical application. Artif Cells Nanomed Biotechnol, 2017, 45(8): 1464-1466.
39. Wang S, Yang X, Liu K, et al. Therapeutic potential of omaveloxolone in counteracting muscle atrophy post-denervation: a multi-omics approach. J Transl Med, 2024, 22(1): 991. doi: 10.1186/s12967-024-05810-7.
40. Liu Z, Liu Y, Yushan M, et al. Enhanced nerve regeneration by bionic conductive nerve scaffold under electrical stimulation. Front Neurosci, 2022, 16: 810676. doi: 10.3389/fnins.2022.810676.
41. Li T, Cheng Q, Zhang J, et al. A novel flexible nerve guidance conduit promotes nerve regeneration while providing excellent mechanical properties. Neural Regen Res, 2025, 20(7): 2084-2094.
42. Kenji K, Hasegawa H, Omokawa S, et al. Anatomical study of vulnerable sensory and expendable motor nerves for targeted muscle reinnervation in the upper extremity. J Plast Surg Hand Surg, 2025, 60: 35-39.
43. Adidharma W, Khouri AN, Lee JC, et al. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve, 2022, 66(4): 384-396.

Chinese Journal of Reparative and Reconstructive Surgery

Targeted muscle reinnervation for treatment of painful stump neuroma

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