Transradial Amputation and Wrist Disarticulation

Transradial amputations represent the most common level of amputation in the upper extremity proximal to the fingers. While patients following forearm-level amputations have a high rate of phantom limb pain and utilization of neuropathic medications, they are also the most likely upper extremity amputees to utilize a prosthesis and remain in the work-force. The advent and evolution of active nerve management strategies such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have revolutionized amputation surgery. Initially developed to facilitate prosthetic control, TMR and by extension, RPNI have been shown to significantly mitigate neuroma pain and phantom limb pain. The use of these techniques should be considered in most patients undergoing major limb amputation. The continuous development of improved prosthetic technologies has led to a refinement of paradigms for amputation throughout the body, and forearm-level amputation is no different. In this chapter, we will outline the conceptual framework for TMR/RPNI, discuss its role in forearm-level amputations, review pearls and pitfalls for the surgeon performing these procedures, and outline our algorithm and approach in performing transradial amputation and wrist disarticulation.