Prosthesis use among individuals with limb loss after targeted muscle reinnervation/regenerative peripheral nerve interface for symptomatic neuromas: A scoping review.

Abstract

Neuromas are aberrant axonal growths that may develop after amputations and contribute to residual-limb and/or phantom-limb pain. Burgeoning surgical approaches for treating neuroma pain include targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) surgery. However, little is known regarding functional outcomes postoperatively. The scoping review aimed to examine prosthesis outcomes among individuals with acquired amputations who have undergone TMR and/or RPNI surgery for neuromas. The study protocol was published on Open Science Framework. A search was conducted across MEDLINE (OVID), EMBASE (OVID), CINAHL Plus (EBSCO), Cochrane Library, and Web of Science. An ascendancy approach was used to assess citation lists of select articles. Two reviewers screened abstracts and full texts after pilot testing, with input from a senior reviewer. Nineteen studies were included. The studies predominantly assessed: TMR only (n = 15), upper extremity amputation only (n = 13), traumatic amputation only (n = 8), and many were case reports or case series (n = 13). Thirteen studies reported prosthesis use pre- and postoperatively. Eleven studies indicated positive change in prosthesis use postoperatively. Two studies indicated no change. Variable outcome measures were used to describe prosthetic use post-TMR/RPNI surgery. In conclusion, literature regarding prosthesis outcomes post-TMR/RPNI surgery is insufficient to support a systematic review. Observations regarding prosthesis use must be interpreted within the context of multiple limitations. Minimal information is available regarding timing of prosthesis wear initiation, prosthesis tolerance, and barriers to prosthesis use. Larger studies are required to support the development of postsurgical rehabilitation protocols.