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Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation

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Abstract

Targeted muscle reinnervation (TMR) was originally developed as a means for increasing intuitive prosthesis control, though later found to play a role in phantom limb pain and neuroma prevention. There is a paucity of literature describing the clinical course of patients with poor TMR surgical outcomes and the value of imaging in the postoperative recovery period. This report will illustrate the potential utility of ultrasound neurography to accurately differentiate TMR surgical outcomes in two patients that received upper extremity amputation and subsequent reconstruction with TMR. Ultrasound evaluation of TMR sites in patient 1 confirmed successful reinnervation, evident by nerve fascicle continuity and eventual integration of the transferred nerve into the target muscle. Conversely, the ultrasound of patient 2 showed discontinuity of the nerve fascicles, neuroma formation, and muscle atrophy in all three sites of nerve transfer, suggesting an unsuccessful procedure and poor functional recovery. Ultrasound neurography is uniquely able to capture the longitudinal trajectory of rerouted nerves to confirm continuity and eventual reinnervation into muscle. Therefore, the application of ultrasound in a postoperative setting can correctly identify instances of failed TMR before this information would become available through clinical evaluation. Early identification of poor TMR outcomes may benefit future patients by fostering the discovery of failure mechanisms and aiding in further surgical planning to improve functional outcomes.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Dewitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Emily R. Finkelstein & Natalia Fullerton

  2. Division of Plastic Surgery, University of Miami Hospital, 1400 NW 12Th Ave, Miami, FL, 33136, USA

    Emily R. Finkelstein

  3. Department of Orthopedic Surgery, Divison of Hand, Peripheral Nervem and Upper Extremity Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA

    Helen Hui-Chou

  4. Department of Clinical Radiology, University of Miami Miller School of Medicine, Miami, FL, USA

    Jean Jose

Authors
  1. Emily R. Finkelstein
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  2. Helen Hui-Chou
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  3. Natalia Fullerton
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Corresponding author

Correspondence to Emily R. Finkelstein.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Specific informed consent was not required by the two individual patients for this study. Rather, all patients at our institution are preoperatively consented for the sharing of non-identifiable information in the form of case reports, including intraoperative and radiologic images. Both study patients signed this preoperative consent.

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The authors declare no competing interests.

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Finkelstein, E.R., Hui-Chou, H., Fullerton, N. et al. Experience with ultrasound neurography for postoperative evaluation of targeted muscle reinnervation. Skeletal Radiol 53, 811–816 (2024). https://doi.org/10.1007/s00256-023-04441-1

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  • DOI: https://doi.org/10.1007/s00256-023-04441-1

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