The neurobiology of targeted muscle reinnervation for post-amputation pain

Targeted muscle reinnervation (TMR) is a peripheral nerve procedure that can prevent and treat postamputation pain. The nerve transfer allows for organized nerve regeneration and repair after amputation surgery. The procedure can successfully prevent neuromas despite large size mismatches between the donor and recipient nerves. Here, we discuss the fundamentals of peripheral nerve injury and regeneration as it pertains to TMR. We propose axonal pruning to explain axon behavior when there are large size mismatches between transferred nerves. Given the increasing use of TMR for amputees, future studies should investigate the basic science of peripheral nerves in TMR. Advances in this field have the potential to significantly improve clinical outcomes for these patients.