Targeted Reinnervation for Transhumeral Amputees: Current Surgical Technique and Update on Results

Background: Targeted reinnervation in upper extremity transhumeral amputees can improve control and dexterity of myoelectric prostheses. The operation as described previously required a long residual limb and the presence of a brachialis muscle. Methods: Brachial plexus dissections were performed to confirm and better understand the branching pattern of the radial nerve in the upper arm. A simplified surgical approach for targeted reinnervation in transhumeral amputees was devised. This study reports on the first six transhumeral amputees who have undergone this simplified procedure. Results: The long and lateral heads of the triceps receive distinct and separate motor nerves from the proximal radial nerve. This anatomy allows a nerve transfer of the distal radial nerve to the motor nerve of the lateral head of the triceps without injury to the innervation of the long head of the triceps. The median nerve transfer to the motor branch of the medial head of the biceps is performed on the anterior surface of the arm as described previously. All six patients had successful targeted reinnervation procedures using this simplified approach. Conclusion: Targeted reinnervation for transhumeral amputees can now be performed in patients with amputations at the level of the middle of the humerus or longer. (Plast. Reconstr. Surg. 124: 863, 2009.)