Procedure Grafts Muscles Over Nerve Endings to Encourage Regeneration

Regenerative peripheral nerve interface (RPNI) surgery is performed in patients undergoing limb amputation or in patients with painful neuromas after nerve injury.

When a nerve is severed or injured, it attempts to regenerate. If the nerve does not have a clear target to regenerate towards, this process can result in a disorganized mass of nerve tissue called a neuroma.

RPNI surgery involves harvesting small portions of muscle from the body (muscle grafts) and placing them over severed nerve endings, providing the nerve with muscle to reinnervate. The new muscle target encourages the nerve to regenerate in an organized fashion, rather than disorganized regeneration that can lead to neuroma formation and pain.

Peripheral nerves are severed during amputation, resulting in nerve endings that can form neuromas or cause phantom limb pain. RPNI surgery can be performed after limb amputation to prevent formation of painful neuromas and decrease phantom limb pain.

RPNI surgery can also improve the ability to use and control certain types of prosthetics. In appropriate candidates, RPNI surgery can be performed at the time of amputation or in a delayed setting after amputation.

Neuromas can occur after any peripheral nerve injury. Neuromas that are painful and unresponsive to other treatments can be treated with surgical excision. RPNI surgery can be performed after neuroma removal to decrease the chance of it coming back.