{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:17:24Z","timestamp":1787732244552,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Complex regional pain syndrome (CRPS) can result in a devastating condition. For a small number of patients, there is a non-response to any existing multimodal therapies and they ultimately request amputation. Such a drastic and final decision is not easy to take for both the patient and the surgeon and requires careful and interdisciplinary assessments and considerations. Furthermore, new surgical procedures, such as targeted muscle reinnervation (TMR) and hybrid prosthetic fitting, and multidisciplinary board advice should be included when considering amputation. In order to help other therapeutic teams in decision making for such rare but more than demanding cases, we aimed to propose an advanced algorithm for amputation indications in CRPS patients combining all these new factors. This algorithm consists of extensive pre-operative psychiatric assessment, diagnostic hybrid prosthetic fitting including fMRI analyses, multidisciplinary board advice as well as targeted muscle reinnervation and amputation procedures with final prosthetic fitting and rehabilitation. By involving multiple disciplines, this algorithm should provide optimized and individualized patient treatment on the one hand and a reliable base for decision making for therapists on the other.<\/jats:p>","DOI":"10.3390\/jpm12071169","type":"journal-article","created":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T05:37:53Z","timestamp":1658209073000},"page":"1169","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["An Algorithm for Elective Amputation Combined with Targeted Muscle Reinnervation in Complex Regional Pain Syndrome\u2014A Perspective"],"prefix":"10.3390","volume":"12","author":[{"given":"Martin","family":"Aman","sequence":"first","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahram","family":"Biglari","sequence":"additional","affiliation":[{"name":"Department of Paraplegia and Technical Orthopaedics, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0337-8570","authenticated-orcid":false,"given":"Mirjam","family":"Thielen","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3580-8486","authenticated-orcid":false,"given":"Arne H.","family":"Boecker","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1063-7510","authenticated-orcid":false,"given":"Annette","family":"Stolle","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological University Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2826-2793","authenticated-orcid":false,"given":"Emre","family":"Gazyakan","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3402-2860","authenticated-orcid":false,"given":"Ulrich","family":"Kneser","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7061-0512","authenticated-orcid":false,"given":"Leila","family":"Harhaus","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, Department of Plastic and Hand Surgery, University of Heidelberg, BG Trauma Hospital Ludwigshafen, 67071 Ludwigshafen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s40122-021-00279-4","article-title":"Complex Regional Pain Syndrome: A Comprehensive Review","volume":"10","author":"Taylor","year":"2021","journal-title":"Pain Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"jrm00087","DOI":"10.2340\/16501977-2718","article-title":"Outcomes of amputation due to long-standing therapy-resistant complex regional pain syndrome type I","volume":"52","author":"Geertzen","year":"2020","journal-title":"J. Rehabil. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.mehy.2018.08.026","article-title":"Decision making process for amputation in case of therapy resistant complex regional pain syndrome type-I in a Dutch specialist centre","volume":"121","author":"Schrier","year":"2018","journal-title":"Med. Hypotheses"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s00508-019-1518-1","article-title":"Bionic reconstruction: Restoration of extremity function with osseointegrated and mind-controlled prostheses","volume":"131","author":"Aman","year":"2019","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1302\/2058-5241.4.190008","article-title":"Quality of life after amputation in patients with advanced complex regional pain syndrome: A systematic review","volume":"4","author":"Ayyaswamy","year":"2019","journal-title":"Efort Open Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/JPO.0b013e3180d09e45","article-title":"Case Report: Functional Status After Transfemoral Amputation in Three Patients With Complex Regional Pain Syndrome","volume":"19","author":"Schmitz","year":"2007","journal-title":"J. Prosthet. Orthot."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1302\/0301-620X.77B2.7706345","article-title":"Amputation for reflex sympathetic dystrophy","volume":"77","author":"Dielissen","year":"1995","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"838","DOI":"10.3109\/09638288.2013.822023","article-title":"Resilience in patients with amputation because of Complex Regional Pain Syndrome type I","volume":"36","author":"Bodde","year":"2014","journal-title":"Disabil. Rehabil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pmr.2005.10.001","article-title":"Targeted reinnervation for improved prosthetic function","volume":"17","author":"Kuiken","year":"2006","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/aor.13422","article-title":"Bionic hand as artificial organ: Current status and future perspectives","volume":"43","author":"Aman","year":"2019","journal-title":"Artif. Organs"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1002\/micr.30653","article-title":"Targeted muscle reinnervation at the time of amputation in the management of complex regional pain syndrome of the lower extremity","volume":"40","author":"Stoehr","year":"2020","journal-title":"Microsurgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.hcl.2021.05.006","article-title":"Targeted Muscle Reinnervation for Prosthetic Control","volume":"37","author":"Bergmeister","year":"2021","journal-title":"Hand Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/BTO.0000000000000194","article-title":"Targeted Muscle Reinnervation for the Upper and Lower Extremity","volume":"32","author":"Kuiken","year":"2017","journal-title":"Tech. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1097\/PRS.0000000000005133","article-title":"Targeted Muscle Reinnervation Technique in Below-Knee Amputation","volume":"143","author":"Bowen","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"eaau2956","DOI":"10.1126\/sciadv.aau2956","article-title":"Peripheral nerve transfers change target muscle structure and function","volume":"5","author":"Bergmeister","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3389\/fnins.2017.00421","article-title":"Broadband Prosthetic Interfaces: Combining Nerve Transfers and Implantable Multichannel EMG Technology to Decode Spinal Motor Neuron Activity","volume":"11","author":"Bergmeister","year":"2017","journal-title":"Front. Neurosci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S1474-4422(02)00074-1","article-title":"Phantom-limb pain: Characteristics, causes, and treatment","volume":"1","author":"Flor","year":"2002","journal-title":"Lancet Neurol."},{"key":"ref_18","first-page":"4","article-title":"Cortical plasticity induced by different degrees of peripheral nerve injuries: A rat functional magnetic resonance imaging study under 9.4 Tesla","volume":"8","author":"Li","year":"2013","journal-title":"J. Brachial Plex. Peripher. Nerve Inj."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.apmr.2005.03.031","article-title":"Phantom pain, residual limb pain, and back pain in amputees: Results of a national survey","volume":"86","author":"Ephraim","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0304-3959(00)00264-5","article-title":"Phantom pain and phantom sensations in upper limb amputees: An epidemiological study","volume":"87","author":"Kooijman","year":"2000","journal-title":"Pain"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1097\/01.ajp.0000177793.01415.bd","article-title":"Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease","volume":"22","author":"Richardson","year":"2006","journal-title":"Clin. J. Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1302\/0301-620X.98B4.36422","article-title":"Amputation in patients with complex regional pain syndrome: A comparative study between amputees and non-amputees with intractable disease","volume":"98-B","author":"Midbari","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/SLA.0000000000003088","article-title":"Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial","volume":"270","author":"Dumanian","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pain.2010.04.030","article-title":"Validation of proposed diagnostic criteria (the \u201cBudapest Criteria\u201d) for Complex Regional Pain Syndrome","volume":"150","author":"Harden","year":"2010","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kotsougiani-Fischer, D., Fischer, S., Warszawski, J., Gruetzner, P.A., Reiter, G., Hirche, C., and Kneser, U. (2021). Multidisciplinary team meetings for patients with complex extremity defects: A retrospective analysis of treatment recommendations and prognostic factors for non-implementation. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01169-4"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/brain\/aws316","article-title":"The desire for healthy limb amputation: Structural brain correlates and clinical features of xenomelia","volume":"136","author":"Hilti","year":"2013","journal-title":"Brain J. Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gandola, M., Zapparoli, L., Saetta, G., Reverberi, C., Salvato, G., Squarza, S.A.C., Invernizzi, P., Sberna, M., Brugger, P., and Bottini, G. (2021). Brain Abnormalities in Individuals with a Desire for a Healthy Limb Amputation: Somatosensory, Motoric or Both? A Task-Based fMRI Verdict. Brain Sci., 11.","DOI":"10.3390\/brainsci11091248"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.jpain.2020.12.003","article-title":"Modifications in fMRI Representation of Mental Rotation Following a 6 Week Graded Motor Imagery Training in Chronic CRPS Patients","volume":"22","author":"Strauss","year":"2021","journal-title":"J. Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.bjps.2018.08.017","article-title":"Updated guidelines on complex regional pain syndrome in adults\u2730","volume":"72","author":"Henderson","year":"2019","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.3171\/2016.6.JNS16154","article-title":"Algorithm for bionic hand reconstruction in patients with global brachial plexopathies","volume":"127","author":"Hruby","year":"2017","journal-title":"J. Neurosurg."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/7\/1169\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:53:32Z","timestamp":1760140412000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/12\/7\/1169"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,19]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jpm12071169"],"URL":"https:\/\/doi.org\/10.3390\/jpm12071169","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,19]]}}}