Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain
Journal article, 2024
Surgical procedures, including nerve reconstruction and end-organ muscle reinnervation, have become more prominent in the prosthetic field over the past decade. Primarily developed to increase the functionality of prosthetic limbs, these surgical procedures have also been found to reduce postamputation neuropathic pain. Today, some of these procedures are performed more frequently for the management and prevention of postamputation pain than for prosthetic fitting, indicating a significant need for effective solutions to postamputation pain. One notable emerging procedure in this context is the Regenerative Peripheral Nerve Interface (RPNI). RPNI surgery involves an operative approach that entails splitting the nerve end longitudinally into its main fascicles and implanting these fascicles within free denervated and devascularized muscle grafts. The RPNI procedure takes a proactive stance in addressing freshly cut nerve endings, facilitating painful neuroma prevention and treatment by enabling the nerve to regenerate and innervate an end organ, i.e., the free muscle graft. Retrospective studies have shown RPNI's effectiveness in alleviating postamputation pain and preventing the formation of painful neuromas. The increasing frequency of utilization of this approach has also given rise to variations in the technique. This article aims to provide a step-by-step description of the RPNI procedure, which will serve as the standardized procedure employed in an international, randomized controlled trial (ClinicalTrials.gov, NCT05009394). In this trial, RPNI is compared to two other surgical procedures for postamputation pain management, specifically, Targeted Muscle Reinnervation (TMR) and neuroma excision coupled with intra-muscular transposition and burying.
Author
Emily Pettersen
Sahlgrenska University Hospital
IRCCS Istituto Ortopedico Rizzoli
Chalmers, Electrical Engineering
Paolo Sassu
IRCCS Istituto Ortopedico Rizzoli
Francesca Alice Pedrini
IRCCS Istituto Ortopedico Rizzoli
Sahlgrenska University Hospital
Hannes Granberg
Sahlgrenska University Hospital
Carina Reinholdt
Sahlgrenska University Hospital
Juan Manuel Breyer
Worker Hospital
Aidan D. Roche
University of Edinburgh
Andrew Hart
Canniesburn Plastic Surgery Unit
University of Glasgow
Adil Ladak
University of Alberta
Hollie Power
University of Alberta
Michael Leung
Dandenong Hospital
Michael Lo
Dandenong Hospital
Ian Valerio
Massachusetts General Hospital
Kyle R. Eberlin
Massachusetts General Hospital
Jason Ko
Northwestern University
Gregory A. Dumanian
Northwestern University
Theodore A. Kung
University of Michigan
Paul S. Cederna
University of Michigan
Max Jair Ortiz Catalan
IRCCS Istituto Ortopedico Rizzoli
Sahlgrenska University Hospital
University of Melbourne
Prometei Pain Rehabilitation Center
Journal of Visualized Experiments
1940-087X (ISSN)
Vol. 2024 205 e66378Subject Categories
Physiotherapy
DOI
10.3791/66378