International Conference On Orthopedics Sports Medicine

        

                          Mayo Clinic is employing a new method of pain prevention as part of limb amputation, heading off post-amputation morbidity from the formation of neuromas, which contribute to residual limb pain (RLP) and phantom limb pain (PLP). Until recently, traditional interventions for post-amputation neuromas have been unsuccessful: Neuroma recurrence rates were high.

                         The new method, regenerative peripheral nerve interface (RPNI), has been studied both preclinically and clinically. It prophylactically reduces potentially symptomatic neuromas through autologous free muscle grafts, often from the amputated limb, implanting the ends of transected nerves into the graft and supplying regenerating axons, reinnervating end organs and creating new neuromuscular junctions.

   

                           

                         RPNI is active prevention of neuroma," says Shelley S. Noland, M.D., a hand and peripheral nerve surgeon at Mayo Clinic's campus in Arizona, and a major user of the RPNI technique. "Placing the nerve endings into muscle graft tissue gives the nerves somewhere to go and something to do."

Active, effective prevention versus inconsistent, passive prevention                

          The traditional method of deterring neuroma formation involved attempting to bury the nerve ends at the amputation site, effectively placing them away from the surface. However, Dr. Noland indicates high failure rates with these techniques, primarily because the buried nerves did not stay in place.

                          Physicians developed RPNI because former amputation techniques were inconsistently successful for pain prevention and did not offer the severed nerves a function, which all nerves instinctively seek.

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