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Lee JC, Kemp SW, Kung TA. Regenerative Peripheral Nerve Interface Surgery for the Management of Chronic Posttraumatic Neuropathic Pain. Semin Plast Surg 2024; 38:19-24. [PMID: 38495062 PMCID: PMC10942837 DOI: 10.1055/s-0043-1778078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Chronic pain resulting from peripheral nerve injury remains a common issue in the United States and affects 7 to 10% of the population. Regenerative Peripheral Nerve Interface (RPNI) surgery is an innovative surgical procedure designed to treat posttraumatic neuropathic pain, particularly when a symptomatic neuroma is present on clinical exam. RPNI surgery involves implantation of a transected peripheral nerve into an autologous free muscle graft to provide denervated targets to regenerating axons. RPNI surgery has been found in animal and human studies to be highly effective in addressing postamputation pain. While most studies have reported its uses in the amputation patient population for the treatment of neuroma and phantom limb pain, RPNI surgery has recently been used to address refractory headache, postmastectomy pain, and painful donor sites from the harvest of neurotized flaps. This review summarizes the current understanding of RPNI surgery for the treatment of chronic neuropathic pain.
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Affiliation(s)
- Jennifer C. Lee
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Stephen W.P. Kemp
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Theodore A. Kung
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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González-Prieto J, Cristóbal L, Arenillas M, Giannetti R, Muñoz Frías JD, Alonso Rivas E, Sanz Barbero E, Gutiérrez-Pecharromán A, Díaz Montero F, Maldonado AA. Regenerative Peripheral Nerve Interfaces (RPNIs) in Animal Models and Their Applications: A Systematic Review. Int J Mol Sci 2024; 25:1141. [PMID: 38256216 PMCID: PMC10816042 DOI: 10.3390/ijms25021141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Regenerative Peripheral Nerve Interfaces (RPNIs) encompass neurotized muscle grafts employed for the purpose of amplifying peripheral nerve electrical signaling. The aim of this investigation was to undertake an analysis of the extant literature concerning animal models utilized in the context of RPNIs. A systematic review of the literature of RPNI techniques in animal models was performed in line with the PRISMA statement using the MEDLINE/PubMed and Embase databases from January 1970 to September 2023. Within the compilation of one hundred and four articles employing the RPNI technique, a subset of thirty-five were conducted using animal models across six distinct institutions. The majority (91%) of these studies were performed on murine models, while the remaining (9%) were conducted employing macaque models. The most frequently employed anatomical components in the construction of the RPNIs were the common peroneal nerve and the extensor digitorum longus (EDL) muscle. Through various histological techniques, robust neoangiogenesis and axonal regeneration were evidenced. Functionally, the RPNIs demonstrated the capability to discern, record, and amplify action potentials, a competence that exhibited commendable long-term stability. Different RPNI animal models have been replicated across different studies. Histological, neurophysiological, and functional analyses are summarized to be used in future studies.
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Affiliation(s)
- Jorge González-Prieto
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Lara Cristóbal
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Mario Arenillas
- Animal Medicine and Surgery Department, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Romano Giannetti
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - José Daniel Muñoz Frías
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - Eduardo Alonso Rivas
- Institute for Research in Technology, ICAI School of Engineering, Comillas Pontifical University, 28015 Madrid, Spain; (R.G.); (J.D.M.F.)
| | - Elisa Sanz Barbero
- Peripheral Nerve Unit, Neurophysiology Department, University Hospital of Getafe, 28905 Madrid, Spain;
| | - Ana Gutiérrez-Pecharromán
- Peripheral Nerve Unit, Pathological Anatomy Department, University Hospital of Getafe, 28905 Madrid, Spain;
| | - Francisco Díaz Montero
- Department of Design, BAU College of Arts & Design of Barcelona, 28036 Barcelona, Spain;
| | - Andrés A. Maldonado
- Peripheral Nerve Unit, Department of Plastic Surgery, University Hospital of Getafe, 28905 Madrid, Spain; (J.G.-P.); (L.C.)
- Department of Medicine, Faculty of Biomedical Science and Health, Universidad Europea de Madrid, 28670 Madrid, Spain
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Senger JLB, Hardy P, Thorkelsson A, Duia S, Hsiao R, Kemp SWP, Tenorio G, Rajshekar M, Kerr BJ, Chan KM, Rabey KN, Webber CA. A Direct Comparison of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces to Prevent Neuroma Pain. Neurosurgery 2023; 93:1180-1191. [PMID: 37265342 DOI: 10.1227/neu.0000000000002541] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) surgeries manage neuroma pain; however, there remains considerable discord regarding the best treatment strategy. We provide a direct comparison of TMR and RPNI surgery using a rodent model for the treatment of neuroma pain. METHODS The tibial nerve of 36 Fischer rats was transected and secured to the dermis to promote neuroma formation. Pain was assessed using mechanical stimulation at the neuroma site (direct pain) and von Frey analysis at the footpad (to assess tactile allodynia from collateral innervation). Once painful neuromas were detected 6 weeks later, animals were randomized to experimental groups: (a) TMR to the motor branch to biceps femoris, (b) RPNI with an extensor digitorum longus graft, (c) neuroma excision, and (d) neuroma in situ. The TMR/RPNIs were harvested to confirm muscle reinnervation, and the sensory ganglia and nerves were harvested to assess markers of regeneration, pain, and inflammation. RESULTS Ten weeks post-TMR/RPNI surgery, animals had decreased pain scores compared with controls ( P < .001) and they both demonstrated neuromuscular junction reinnervation. Compared with neuroma controls, immunohistochemistry showed that sensory neuronal cell bodies of TMR and RPNI showed a decrease in regeneration markers phosphorylated cyclic AMP receptor binding protein and activation transcription factor 3 and pain markers transient receptor potential vanilloid 1 and neuropeptide Y ( P < .05). The nerve and dorsal root ganglion maintained elevated Iba-1 expression in all cohorts. CONCLUSION RPNI and TMR improved pain scores after neuroma resection suggesting both may be clinically feasible techniques for improving outcomes for patients with nerve injuries or those undergoing amputation.
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Affiliation(s)
- Jenna-Lynn B Senger
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
- Division of Plastic & Reconstructive Surgery, University of British Columbia, Vancouver , BC , Canada
| | - Paige Hardy
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
| | - Aline Thorkelsson
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
| | - Shirley Duia
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
| | - Ralph Hsiao
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Gustavo Tenorio
- Department of Anesthesiology, University of Alberta, Edmonton , AB , Canada
| | - Mithun Rajshekar
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton , AB , Canada
| | - Bradley J Kerr
- Department of Anesthesiology, University of Alberta, Edmonton , AB , Canada
| | - K Ming Chan
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton , AB , Canada
| | - Karyne N Rabey
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
- Department of Anthropology, University of Alberta, Edmonton , AB , Canada
| | - Christine A Webber
- Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada
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