Related Experiment Video
Updated: May 6, 2026
Fabrication of the Composite Regenerative Peripheral Nerve Interface C-RPNI in the Adult Rat
Published on: February 25, 2020
Prophylactic Regenerative Peripheral Nerve Interface Surgery in Pediatric Lower Limb Amputation Patients
Ahneesh J Mohanty1, Paul S Cederna1,2, Stephen W P Kemp1,2
1Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI.
Insights
Regenerative Peripheral Nerve Interface (RPNI) surgery may prevent chronic pain in pediatric amputees. This study found RPNI significantly reduced post-amputation pain and neuroma incidence in young patients.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Regenerative Medicine
Background:
- Chronic post-amputation pain affects up to 83% of pediatric limb loss patients.
- This pain leads to disability and reduced quality of life.
- Current treatments for pediatric post-amputation pain are often ineffective.
Purpose of the Study:
- To evaluate the prophylactic effect of Regenerative Peripheral Nerve Interface (RPNI) surgery on pediatric post-amputation pain.
- To assess if RPNI surgery reduces the incidence of symptomatic neuroma and phantom limb pain.
- To determine if RPNI surgery limits analgesic use in pediatric patients with limb loss.
Main Methods:
- Retrospective chart review of pediatric patients (ages 8-21) undergoing major lower limb amputation.
- Comparison between patients who received RPNI surgery and those who did not (controls).
- Analysis of neuroma pain, phantom limb pain scores, and analgesic use (MME/day, MQSIII).
Main Results:
- Seventy-nine percent of control patients developed chronic pain versus 21% of RPNI patients (P<0.001).
- Zero percent of RPNI patients developed clinical neuroma pain compared to 20% of controls (P<0.001).
- RPNI patients showed significantly decreased pain scores (P=0.007) and narcotic usage (P<0.01).
Conclusions:
- Prophylactic RPNI surgery shows promise in preventing symptomatic neuromas in pediatric amputees.
- RPNI surgery may help prevent the development of phantom limb pain in this population.
- RPNI surgery is a potential strategy to improve outcomes for pediatric limb loss patients.
Objective:
To evaluate the prophylactic effect of regenerative peripheral nerve interface (RPNI) surgery on pediatric postamputation pain.
Background:
Chronic postamputation pain is a debilitating and refractory sequela of limb amputation affecting up to 83% of pediatric patients with limb loss, resulting in disability and decreased quality of life. We postulate that prophylactic RPNI surgery performed during amputation may decrease the incidence of symptomatic neuroma and development of phantom limb pain, as well as limit analgesic use among pediatric patients with limb loss.
Methods:
Retrospective chart review was performed on pediatric patients between the ages of 8 and 21 years who underwent major lower limb amputation with and without RPNI surgery. Documented neuroma and phantom limb pain scores, as well as analgesic use, were recorded. Narcotic use was converted to milligrams morphine equivalents per day, whereas overall analgesic use was converted to Medication Quantification Scale version III scores. Analysis was performed using Stata.
Results:
Forty-four pediatric patients were identified; 25 RPNI patients and 19 controls. Of control patients, 79% developed chronic postamputation pain versus 21% of RPNI patients ( P < 0.001). Among the patients who developed postamputation pain, 20% of controls developed clinical neuroma pain, compared with 0% of RPNI patients ( P < 0.001). In addition, RPNI patients demonstrated a significant decrease in pain score ( P = 0.007) and narcotic usage ( P < 0.01) compared with controls. Overall analgesic use did not vary significantly between groups.
Conclusions:
Prophylactic RPNI surgery shows promise for pediatric patients undergoing major lower limb amputation by preventing both symptomatic neuromas and possibly the development of phantom limb pain.
More Related Videos
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management