inMotion Magazine

May | June 2019 22 Surgeons have devised numerous procedures to minimize or eliminate the painful symptoms of neuromas, but effective treatment has been largely elusive. Prevailing standard practice involves burying nerve endings from the amputated limb in a nearby muscle – essentially hiding a hot nerve ending, with limited success at reducing pain. A related condition, PLP, is thought to be a complex interplay between painful neuromas and the central nervous system – and has proven even more difficult to prevent or reverse, with no treatment regarded as universally effective. “Our nervous system is like an electric grid, and severed nerves are like live wires that cause pain,” Dumanian explains. TMR dissects the amputated nerve – the “live wire” – and surgically reroutes it to reinnervate a nearby functionless muscle, thereby “closing the circuit.” The reinnervation process allows the nerve to find end- receptors within the muscle, fooling the nerves into feeling “healed” and, more importantly, less painful. “Simply put, TMR gives the nerves somewhere to go and something to do, a strategy absent from all other neuroma treatments,” he says. Dumanian was the first to perform TMR surgery in 2002 to enable patients to control advanced myoelectric (bionic) prostheses. While the procedure’s implications for prosthetics drew international attention, Dumanian also observed that TMR patients experienced less pain, making it a potential treatment for a broader population of amputees. These observations were published in a retrospective study in 2014, but the latest findings are the first to demonstrate significant improvements in a randomized, multi-center study. In the recently published trial, 28 amputees with chronic pain were assigned to either standard treatment or TMR. Researchers gathered information including patient-rated pain scores, neuroma size and functionality data at six months, 12 months and 18 months post-procedure. Patients in the study did not know whether they had received TMR or standard treatment for a full year after surgery. Notably, three study participants who originally underwent standard treatment opted to have TMR performed after the 12-month mark, including Philizaire. Eleven of the limbs treated with TMR had been amputated for five to 10 years or more. “Critically, we found that there’s really no shelf life on TMR,” Dumanian says, also noting that there were no surgical complications to report. “It’s not too late to have the procedure if you’re more than a decade post- amputation, or if you’ve had nerve surgeries in the past, which is common among the amputee community.” Dumanian, a triple board-certified fourth generation Armenian-American surgeon, is on a mission to encourage the use of TMR to provide much-needed relief for amputees. As a plastic surgeon, he regularly lectures at medical conferences around the world, raising awareness about TMR among neurosurgeons and orthopedic surgeons who treat amputee patients in pain. Notably, he has no intellectual property rights and no commercial interests in the TMR procedure. “I am absolutely committed to making sure every person living with an amputation and the doctors who treat them understand the potential of TMR to provide relief from chronic pain,” Dumanian says.  Dr. Gregory Dumanian is chief of plastic surgery at Northwestern University’s Feinberg School of Medicine. He is a surgical innovator who developed targeted muscle reinnervation for the treatment of painful nerve endings and for amputees to move bionic limbs. He also is the creator of Mesh Suture – the first new surgical suture design in 30 years. Dr. Dumanian performs the full range of cosmetic and reconstructive surgery procedures. I am absolutely committed to making sure every person living with an amputation and the doctors who treat them understand the potential of TMR to provide relief from chronic pain. TMR dissects the amputated nerve – the “live wire” – and surgically reroutes it to reinnervate a nearby functionless muscle, thereby “closing the circuit.”