Prophylactic Regenerative Peripheral Nerve Interfaces in Elective Lower Limb Amputations.

Area of Science:

• Regenerative Medicine
• Neurosurgery
• Amputation Surgery

Background:

• Neuromas and phantom limb pain are common complications after lower limb amputation.
• Existing management strategies for post-amputation pain and neuroma formation have limitations.

Purpose of the Study:

• To evaluate the prophylactic efficacy of regenerative peripheral nerve interface (RPNI) in managing post-amputation pain and neuroma formation.
• To compare outcomes in patients undergoing amputation with RPNI versus those without.

Main Methods:

• A comparative study of 28 patients with insulin-dependent diabetes undergoing above-knee (AKA) or below-knee (BKA) amputation.
• Two groups were formed: 14 patients with primary RPNI and 14 patients without.
• Analysis included demographic data, amputation level, operative time, complications, and functional outcomes (PROMIS T-score, VAS score) over a mean 49-week follow-up.

Main Results:

• The RPNI group showed a significant decrease in PROMIS T-score (15.9 points) and VAS pain scores, with all patients reporting no pain.
• In contrast, 78.6% of the non-RPNI group reported severe pain.
• Patients with RPNI demonstrated significantly higher prosthesis utilization (p < 0.005).

Conclusions:

• Prophylactic RPNI surgery at the time of amputation significantly reduces post-amputation pain and prevents neuroma formation.
• RPNI is associated with high patient satisfaction and improved functional outcomes, including increased prosthesis use.
• RPNI is a safe technique that does not increase operative time or complications and warrants further use.