Regenerative Peripheral Nerve Interface Surgery: Anatomic and Technical Guide

Leach, Garrison A; Dean, Riley A.; Kumar, Nishant Ganesh; Tsai, Catherine; Chiarappa, Frank E.; Cederna, Paul S.; Kung, Theodore A.; Reid, Christopher M.

doi:10.1097/gox.0000000000005127

Cited by 10 publications

(5 citation statements)

References 90 publications

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“…In their anatomic and technical guide, Leach and colleagues advocate for a construct that is approximately 3 cm long, 2 cm wide, and 0.5 cm for appropriate revascularization. 9 As mentioned previously, the biggest challenge for TMR remains nerve size mismatch and axonal escape. These axons can be kept contained using a biological nerve wrap that gives escape axons a place to invade instead of allowing their progression to neuroma formation.…”

Section: Discussionmentioning

confidence: 93%

Combined TMR and RPNI in a vasculopathy patient: A case report

Galbraith,

Najafali,

Gatherwright

2023

JPRAS Open

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Section: Discussionmentioning

confidence: 93%

Combined TMR and RPNI in a vasculopathy patient: A case report

Galbraith,

Najafali,

Gatherwright

2023

JPRAS Open

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“…The recent literature on TMR in patients with lower-extremity amputation has not involved a case like ours, and most patients were less than 10 years removed from initial amputation, whereas our patient was 24 years removed. 10 , 11 Overall, it is important to include traumatic neuroma on the differential when treating peripheral nerve tumors but also phantom limb pain after amputation.…”

Section: Discussionmentioning

confidence: 99%

Phantom limb pain, traumatic neuroma, or nerve sheath tumor? Illustrative case

Halloran,

Chiocca,

Santos

2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Phantom limb pain and traumatic neuromas are not commonly seen in neurosurgical practice. These conditions can present with similar symptoms; however, management of traumatic neuroma is often surgical, whereas phantom limb pain is treated with conservative measures. OBSERVATIONS A 77-year-old female patient with a long-standing history of an above-the-knee amputation experienced severe pain in her right posterior buttocks area for several years’ duration, attributed to phantom limb pain, which radiated down the stump of her leg and was treated with a variety of conservative measures. A recent exacerbation of her pain led to a prolonged hospitalization with magnetic resonance imaging of her leg stump, revealing a mass in the sciatic notch, at a relative distance from the stump. The anatomical location of the mass on the sciatic nerve in the notch led to a presumed radiological diagnosis of nerve sheath tumor, for which she underwent excision. At surgery, a neuroma of the proximal portion of the transected sciatic nerve that had retracted from the amputated stump to the notch was diagnosed. LESSONS Traumatic neuromas of transected major nerves after limb amputation should be considered in the differential diagnosis of phantom limb pain.

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“…Additionally, it has superficial surgical access with inconsequential morbidity. 10 The muscle graft was subsequently wrapped around the 2.5 cm transected ends of both the supraorbital and supratrochlear nerves separately. The nerve-muscle graft constructs were left in the superficial superior orbit.…”

Section: Surgical Technique and Clinical Coursementioning

confidence: 99%

Novel Utilization of the Regenerative Peripheral Nerve Interface Technique after Unsuccessful Nerve Release for Bilateral Frontal Migraines

Toliver,

Egan,

Sparks

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Regenerative peripheral nerve interface (RPNI) is a surgical technique whose indications include preventing or treating painful neuromas after amputation or peripheral nerve injuries. The procedure involves implanting the distal end of a transected peripheral nerve containing sensory fibers into a selected free muscle graft. Although RPNI procedures have primarily been used after limb amputations, select case reports detail the potential for RPNI to mitigate other sources of neuropathic pain, introducing novel uses to its clinical utility. We present the case of a 49-year-old woman who presented to our clinic in June 2021 with chronic frontal migraines with right retro-orbital pain. Bilateral supraorbital and supratrochlear nerve releases with fat grafting were performed in August 2018 via a blepharoplasty approach; however, this procedure was unsuccessful in reducing her neuropathic pain. After discussion with the patient, we elected to proceed with transection of bilateral supraorbital and supratrochlear nerves with RPNI. The postoperative course was uneventful. Follow-up visits up to 1-year postoperative revealed that she had adequate pain control, discontinued her migraine medications, and reported satisfaction with the procedure. The novel RPNI surgical technique may be a low-risk adjunctive option in the surgical management of refractory supraorbital and supratrochlear neuralgia. Future studies should include a prospective randomized controlled trial comparing supraorbital and supratrochlear neurectomy alone to neurectomy with RPNI in refractory supraorbital and supratrochlear neuralgia management. Further exploration of RPNI may reveal additional uses and modifications, which may revolutionize the treatment of neuralgia and other similar ailments.

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Regenerative Peripheral Nerve Interface Surgery: Anatomic and Technical Guide

Cited by 10 publications

References 90 publications

Combined TMR and RPNI in a vasculopathy patient: A case report

Combined TMR and RPNI in a vasculopathy patient: A case report

Phantom limb pain, traumatic neuroma, or nerve sheath tumor? Illustrative case

Novel Utilization of the Regenerative Peripheral Nerve Interface Technique after Unsuccessful Nerve Release for Bilateral Frontal Migraines

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