Surgical Techniques for Targeted Muscle Reinnervation

The primary goal of targeted muscle reinnervation (TMR) surgery is to provide high-level upper limb amputees with independent myoelectric sites for prosthesis control. This translates to the preservation of existing sites and the creation of new sites through multiple nerve transfers. The TMR procedure was designed to create control sites for four basic prosthetic functions: elbow flexion, elbow extension, hand open, and hand close. However, because of the desirability of additional wrist and hand control and the potential benefits offered by advanced control algorithms, additional control sites should be created if possible. In this chapter, we present an overview of the surgical technique for transhumeral and shoulder disarticulation amputees, keeping in mind that the ultimate success of the procedure depends on the quality of the tissues of the residual limb, coordination between the surgical and rehabilitation teams, and the postsurgical rehabilitation process.