The University of Maryland Heart and Vascular Center’s Limb Preservation program is pioneering targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), procedures designed to reduce phantom limb pain among amputees. The procedure, performed by Khanjan ‘KJ’ Nagarsheth, MD, vascular surgeon and co-director of the University of Maryland Heart and Vascular Center’s Limb Preservation program, aims to reduce pain and improve quality of life among amputees. University of Maryland Heart and Vascular Center is one of only two centers in the state performing this procedure and has performed the highest volume of TMR surgeries.

In the United States, approximately 1.6 million people are living with limb loss, and 185,000 amputations are performed each year. Of these 1.6 million, 38 percent had a limb amputation secondary to diabetes mellitus. The rate of limb loss is expected to double by 2050.1

Phantom limb pain occurs in up to 85 percent of amputees following major limb amputation.2 Phantom pain contributes to ongoing use of pain medication, including opiates, and is a contributing factor to high one-year and five-year mortality rates among amputees. Therefore, it is a serious quality of life issue for amputees.

TMR is based on the theory that when the peripheral nerve is severed and tied off during a traditional amputation, it scars over and becomes irritated, causing a neuroma. Although the nerve no longer has a function, it continues to send pain signals to the brain. To solve this problem, TMR connects the severed nerve to another nerve going into muscle tissue, therefore creating a new function while eliminating pain signals.

Dr. Nagarsheth and his team are currently conducting quality of life surveys before and after TMR, laying the groundwork for future research. Anecdotally, however, the news is highly encouraging. “Over the last six months, since we’ve begun to perform this procedure, we’ve been able to get almost every patient off pain medications and nerve medications. Previously, it was not uncommon for amputees to need pain medication over the long term. This procedure improves quality of life significantly,” Dr. Nagarsheth said.

The procedure typically adds 30 to 45 minutes to surgical time if performed during an amputation. If performed after amputation, the procedure takes less than an hour. Previous amputees typically spend two to three days in the hospital following this procedure, after which they are discharged home or to acute rehabilitation.

Learn more about the multidisciplinary Limb Preservation program at the University of Maryland Heart and Vascular Center.

View information for referring physicians or call 410-328-5840 to make a referral.

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 Mar;89(3):422-9. doi: 10.1016/j.apmr.2007.11.005. PMID: 18295618.

2 Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil. 2005 Oct;86(10):1910-9. doi: 10.1016/j.apmr.2005.03.031. PMID: 16213230.

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