Targeted Muscle Reinnervation Combined with a Vascularized Pedicled Regenerative Peripheral Nerve Interface

Plastic and Reconstructive Surgery. Global Open
Ian L ValerioKyle R Eberlin

Abstract

Symptomatic neuromas and pain caused by nerve transection injuries can adversely impact a patient's recovery, while also contributing to increased dependence on opioid and other pharmacotherapy. These sources of pain are magnified following amputation surgeries, inhibiting optimal prosthetic wear and function. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) represent modern advances in addressing amputated peripheral nerves. These techniques offer solutions by essentially providing neuromuscular targets for transected peripheral nerves "to grow into and reinnervate." Recent described benefits of these techniques include reports on pain reduction or ablation (eg, phantom limb pain, residual limb pain, and/or neuroma pain).1-6 We describe a technical adaptation combining TMR with a "pedicled vascularized RPNI (vRPNI)." The TMR with the vRPNI surgical technique described offers the advantage of having a distal target nerve and a target muscle possessing deinnervated motor end plates which may potentially enhance nerve regeneration and muscle reinnervation, while also decreasing amputated nerve-related pain.

References

Jan 25, 2011·PM & R : the Journal of Injury, Function, and Rehabilitation·Aimee E Schultz, Todd A Kuiken
Nov 28, 2013·Plastic and Reconstructive Surgery·Theodore A KungPaul S Cederna
Nov 30, 2013·Physical Medicine and Rehabilitation Clinics of North America·Terrence Patrick Sheehan, George C Gondo
Feb 25, 2014·Clinical Orthopaedics and Related Research·Jason M SouzaGregory A Dumanian
Feb 17, 2015·Seminars in Plastic Surgery·Jennifer E CheesboroughGregory A Dumanian
Jun 14, 2016·BioMed Research International·Melanie G UrbanchekPaul S Cederna
May 31, 2018·JAMA Surgery·Carrie A KubiakPaul S Cederna
Dec 12, 2018·Plastic and Reconstructive Surgery. Global Open·Kyle R Eberlin, Ivica Ducic
Jan 12, 2019·Journal of the American College of Surgeons·Ian L ValerioBenjamin K Potter
Jun 15, 2019·Journal of Surgical Oncology·John H AlexanderIan L Valerio

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Citations

Apr 16, 2021·Plastic and Reconstructive Surgery. Global Open·Abhiram R BhashyamDennis S Kao
Oct 16, 2020·Journal of Reconstructive Microsurgery·Jonathan LansKyle R Eberlin
Jun 26, 2021·Plastic and Reconstructive Surgery. Global Open·Nikhil A AgrawalKyle R Eberlin
Jun 15, 2021·Seminars in Plastic Surgery·Rami P DibbsJohn C Koshy
Aug 10, 2021·Frontiers in Neurorobotics·Alison M KarczewskiSamuel O Poore
Feb 5, 2022·Current Pain and Headache Reports·Davis C ThomasReshmy Chellam Pichammal

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Methods Mentioned

BETA
amputation
amputations

Software Mentioned

Kaltura

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