Development of Targeted Muscle Reinnervation Model in Hind Limb Amputated Rats

Abstract

Background Targeted muscle reinnervation (TMR) is a novel approach to postamputation neuroma pain; however, this has not been explicitly studied. The purpose of this study was to develop a TMR model in hind limb amputated rats.

Methods Ten hind limbs from 5 Sprague Dawley cadaver rats were used. Sciatic nerve, main branches of the sciatic nerve (common peroneal, tibial, sural), motor branches from the sciatic nerve to the biceps femoris and cauda femoris, gluteal nerve and its motor branches to the semimembranosus, and biceps femoris and femoral nerve were dissected to look for consistent nerve anatomy that can be used for TMR in the rat hind limb amputation model. Transfemoral amputation was performed and two types of coaptations were made: common peroneal nerve to motor branch to biceps femoris and tibial nerve to motor branch to semimembranosus.

Results The total surgical time for the dissection, amputation, and coaptation of nerves was ∼90 minutes. A total of 100 nerves were dissected in 10 rat hind limbs. Anatomical dissections were straightforward to perform. Anatomy of the dissected nerves was consistent. Hind limb amputations were performed without damaging the target muscles and nerves. Nerve lengths were sufficient for coaptation without any tension.

Conclusions To the best of our knowledge, this is the first report on TMR model in hind limb amputated rats. This model will allow for mechanical, electromyography (EMG), and histological analysis for future assessment of neuroma prevention.

Keywords

rat model - targeted muscle reinnervation - neuroma prevention

• References

• 1 Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (03) 422-429
• 2 Tintle SM, Keeling JJ, Shawen SB, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: part I: general principles and lower-extremity amputations. J Bone Joint Surg Am 2010; 92 (17) 2852-2868
• 3 Chabal C, Jacobson L, Russell LC, Burchiel KJ. Pain response to perineuromal injection of normal saline, epinephrine, and lidocaine in humans. Pain 1992; 49 (01) 9-12
• 4 Gruber H, Glodny B, Kopf H. , et al. Practical experience with sonographically guided phenol instillation of stump neuroma: predictors of effects, success, and outcome. AJR Am J Roentgenol 2008; 190 (05) 1263-1269
• 5 Restrepo-Garces CE, Marinov A, McHardy P, Faclier G, Avila A. Pulsed radiofrequency under ultrasound guidance for persistent stump-neuroma pain. Pain Pract 2011; 11 (01) 98-102
• 6 Dellon AL, Mackinnon SE. Treatment of the painful neuroma by neuroma resection and muscle implantation. Plast Reconstr Surg 1986; 77 (03) 427-438
• 7 Wood VE, Mudge MK. Treatment of neuromas about a major amputation stump. J Hand Surg Am 1987; 12 (02) 302-306
• 8 Balcin H, Erba P, Wettstein R, Schaefer DJ, Pierer G, Kalbermatten DF. A comparative study of two methods of surgical treatment for painful neuroma. J Bone Joint Surg Br 2009; 91 (06) 803-808
• 9 Hijjawi JB, Kuiken TA, Lipschutz RD, Miller LA, Stubblefield KA, Dumanian GA. Improved myoelectric prosthesis control accomplished using multiple nerve transfers. Plast Reconstr Surg 2006; 118 (07) 1573-1578
• 10 Dumanian GA, Ko JH, O'Shaughnessy KD, Kim PS, Wilson CJ, Kuiken TA. Targeted reinnervation for transhumeral amputees: current surgical technique and update on results. Plast Reconstr Surg 2009; 124 (03) 863-869
• 11 Souza JM, Cheesborough JE, Ko JH, Cho MS, Kuiken TA, Dumanian GA. Targeted muscle reinnervation: a novel approach to postamputation neuroma pain. Clin Orthop Relat Res 2014; 472 (10) 2984-2990
• 12 Pet MA, Ko JH, Friedly JL, Mourad PD, Smith DG. Does targeted nerve implantation reduce neuroma pain in amputees?. Clin Orthop Relat Res 2014; 472 (10) 2991-3001
• 13 Kim PS, Ko JH, O'Shaughnessy KK, Kuiken TA, Pohlmeyer EA, Dumanian GA. The effects of targeted muscle reinnervation on neuromas in a rabbit rectus abdominis flap model. J Hand Surg Am 2012; 37 (08) 1609-1616
• 14 Zhou H, Wu F, Yang L. , et al. A preliminary analysis of reconstructed nerve function using targeted muscle reinnervation in a rat model. 6th International IEEE/EMBS Conference on Neural Engineering (NER); 2013 :1602–1605
• 15 Agnew SP, Schultz AE, Dumanian GA, Kuiken TA. Targeted reinnervation in the transfemoral amputee: a preliminary study of surgical technique. Plast Reconstr Surg 2012; 129 (01) 187-194
• 16 Siemionow M, Bobkiewicz A, Cwykiel J, Uygur S, Francuzik W. Epineural sheath jacket as a new surgical technique for neuroma prevention in the rat sciatic nerve model. Ann Plast Surg 2017; 79 (04) 377-384
• 17 Gart MS, Souza JM, Dumanian GA. Targeted muscle reinnervation in the upper extremity amputee: a technical roadmap. J Hand Surg Am 2015; 40 (09) 1877-1888
• 18 Kuiken TA, Barlow AK, Hargrove L, Dumanian GA. Targeted muscle reinnervation for the upper and lower extremity. Tech Orthop 2017; 32 (02) 109-116