Active Nerve Management in Amputation: RPNI as a Strategy to Eliminate Neuroma Formation and Transform Postamputation...

Area of Science:

• Regenerative Peripheral Nerve Interface (RPNI)
• Neuropathic Pain Management
• Amputation Surgery

Background:

• Symptomatic neuroma and chronic pain hinder recovery after lower limb amputation.
• Active nerve management, like RPNI, offers a biological target for nerves to prevent pain.
• RPNI is a promising technique for managing post-amputation pain.

Purpose of the Study:

• To evaluate the efficacy of prophylactic Regenerative Peripheral Nerve Interface (RPNI) in preventing symptomatic neuroma and reducing pain after lower limb amputation.
• To compare outcomes between patients receiving RPNI and those undergoing standard amputation.
• To assess the impact of RPNI on pain intensity, interference, and prosthetic use.

Main Methods:

• Retrospective observational study of 24 adult lower limb amputees.
• Twelve patients received prophylactic RPNI; 12 had standard amputation.
• Evaluated symptomatic neuroma, pain (VAS, PROMIS), and prosthetic use over 12 weeks.

Main Results:

• No symptomatic neuromas in the RPNI group vs. 66.7% in controls (p < 0.001).
• Significantly lower VAS pain scores in the RPNI group (0.4) vs. controls (5.8) at 12 weeks (p < 0.0001).
• Improved PROMIS Pain Interference scores in the RPNI group (44.0) vs. controls (66.0) at 3 months (p < 0.001).

Conclusions:

• Prophylactic RPNI effectively prevents symptomatic neuroma formation after lower limb amputation.
• RPNI significantly reduces post-amputation pain intensity and interference, improving functional outcomes.
• Routine active nerve management with RPNI supports optimized rehabilitation and quality of life for amputees.