Regenerative Peripheral Nerve Interfaces for Treatment of Symptomatic Neuromas

This chapter describes the use of the regenerative peripheral nerve interface (RPNI) as a physiologic solution to treat neuroma pain. The RPNI consists of a free autologous skeletal muscle graft secured around the terminal end of a peripheral nerve. Through numerous animal and human studies, RPNIs have been shown to enable synaptogenesis between the regenerating axons of a peripheral nerve and denervated targets within the autologous skeletal muscle graft to prevent symptomatic neuroma formation. This chapter reviews the contribution of neuroma pain to postamputation pain including its peripheral and central mechanisms, the physiologic basis for the efficacy of RPNIs, and the clinical outcomes of using RPNIs to treat patients with symptomatic neuromas. In addition, the chapter will highlight the operative technique to successfully perform RPNI surgery. By leveraging the physiologic properties of nerve regeneration, muscle revascularization, and muscle reinnervation, RPNIs have been shown to successfully treat and prevent neuroma pain in the upper and lower extremity, as well as improve patient-reported quality of life.