<meta charset="utf8"></head><body>RPNI 手术治疗截肢后疼痛

<ol>
	<li>Hsu, E., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postamputation+pain:+Epidemiology,+mechanisms,+and+treatment.">Postamputation pain: Epidemiology, mechanisms, and treatment.</a> J Pain Res. 6, 121-136 (2013).</li><li>Schug, S. A., Lavand, P., Barke, A., Korwisi, B., Rief, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+IASP+classification+of+chronic+pain+for+ICD-11+chronic+postsurgical+or+posttraumatic+pain.">The IASP classification of chronic pain for ICD-11 chronic postsurgical or posttraumatic pain.</a> Pain. 160 (1), 45-52 (2019).</li><li>Davis, R. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phantom+sensation,+phantom+pain,+and+stump+pain.">Phantom sensation, phantom pain, and stump pain.</a> Arch Phys Med Rehabil. 74 (1), 79-91 (1993).</li><li>Ortiz-Catalan, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+stochastic+entanglement+and+phantom+motor+execution+hypotheses:+A+theoretical+framework+for+the+origin+and+treatment+of+Phantom+limb+pain.">The stochastic entanglement and phantom motor execution hypotheses: A theoretical framework for the origin and treatment of Phantom limb pain.</a> Front Neurol. 9, 748 (2018).</li><li>Flor, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phantom-limb+pain:+Characteristics,+causes,+and+treatment.">Phantom-limb pain: Characteristics, causes, and treatment.</a> Lancet Neurol. 1 (3), 182-189 (2002).</li><li>Rotshenker, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Traumatic Injury to Peripheral Nerves. Nerves and Nerve Injuries. , (2015).</li><li>Stokvis, A., Der Avoort, D. J. J. C., Van Neck, J. W., Hovius, S. E. R., Coert, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+neuroma+pain:+A+prospective+follow-up+study.">Surgical management of neuroma pain: A prospective follow-up study.</a> Pain. 151 (3), 862-869 (2010).</li><li>Curtin, C., Carroll, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cutaneous+neuroma+physiology+and+its+relationship+to+chronic+pain.">Cutaneous neuroma physiology and its relationship to chronic pain.</a> J Hand Surg Am. 34 (7), 1334-1336 (2009).</li><li>Khan, J., Noboru, N., Young, A., Thomas, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pro+and+anti-inflammatory+cytokine+levels+(TNF-&#945;,+IL-1&#946;,+IL-6+and+IL-10)+in+rat+model+of+neuroma.">Pro and anti-inflammatory cytokine levels (TNF-&#945;, IL-1&#946;, IL-6 and IL-10) in rat model of neuroma.</a> Pathophysiology. 24 (3), 155-159 (2017).</li><li>Clark, A. K., Old, E. A., Malcangio, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuropathic+pain+and+cytokines:+current+perspectives.">Neuropathic pain and cytokines: current perspectives.</a> J Pain Res. 6, 803 (2013).</li><li>Costigan, M., Scholz, J., Woolf, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuropathic+pain:+A+maladaptive+response+of+the+nervous+system+to+damage.">Neuropathic pain: A maladaptive response of the nervous system to damage.</a> Annu Rev Neurosci. 32, 1-32 (2009).</li><li>Eberlin, K. R., Ducic, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+algorithm+for+neuroma+management:+A+changing+treatment+paradigm.">Surgical algorithm for neuroma management: A changing treatment paradigm.</a> Plast Reconstr Surg Glob Open. 6 (10), e1952 (2018).</li><li>Ives, G. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+state+of+the+surgical+treatment+of+terminal+neuromas.">Current state of the surgical treatment of terminal neuromas.</a> Neurosurgery. 83 (3), 354-364 (2018).</li><li>Dellon, A. L., Mackinnon, S. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+the+painful+neuroma+by+neuroma+resection+and+muscle+implantation.">Treatment of the painful neuroma by neuroma resection and muscle implantation.</a> Plast Reconstr Surg. 77, 427-438 (1986).</li><li>Neumeister, M. W., Winters, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neuroma.">Neuroma.</a> Clin Plast Surg. 47 (2), 279-283 (2020).</li><li>Guse, D. M., Moran, S. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Outcomes+of+the+surgical+treatment+of+peripheral+neuromas+of+the+hand+and+forearm:+A+25-year+comparative+outcome+study.">Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: A 25-year comparative outcome study.</a> Ann Plast Surg. 71 (6), 654-658 (2013).</li><li>Eftekari, S. C., Nicksic, P. J., Seitz, A. J., Donnelly, D. T., Dingle, A. M., Poore, S. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+symptomatic+neuromas:+a+narrative+review+of+the+most+common+surgical+treatment+modalities+in+amputees.">Management of symptomatic neuromas: a narrative review of the most common surgical treatment modalities in amputees.</a> Plast and Aesthet Res. 9 (7), 43 (2022).</li><li>Dean, R. A., Tsai, C., Chiarappa, F. E., Cederna, P. S., Kung, T. A., Reid, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interface+surgery:+Anatomic+and+technical+guide.">Regenerative peripheral nerve interface surgery: Anatomic and technical guide.</a> Plast Reconstr Surg Glob Open. 11 (7), 5127 (2023).</li><li>Santosa, K. B., Oliver, J. D., Cederna, P. S., Kung, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interfaces+for+prevention+and+management+of+neuromas.">Regenerative peripheral nerve interfaces for prevention and management of neuromas.</a> Clin Plast Surg. 47 (2), 311-321 (2020).</li><li>Cedars, M. G. M. D., Miller, T. A. M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+free+muscle+grafting.">A review of free muscle grafting.</a> Plast Reconstr Surg. 74 (5), 712-720 (1984).</li><li>Hu, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interface+free+muscle+graft+mass+and+function.">Regenerative peripheral nerve interface free muscle graft mass and function.</a> Muscle Nerve. 63 (3), 421-429 (2021).</li><li>Pettersen, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+treatments+for+postamputation+pain+study+protocol+for+an+international+,+double+-+blind,+randomised+controlled+trial.">Surgical treatments for postamputation pain study protocol for an international , double - blind, randomised controlled trial.</a> Trials. 24 (1), 304 (2023).</li><li>Woo, S. L., Kung, T. A., Brown, D. L., Leonard, J. A., Kelly, B. M., Cederna, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interfaces+for+the+treatment+of+postamputation+neuroma+pain:+A+pilot+study.">Regenerative peripheral nerve interfaces for the treatment of postamputation neuroma pain: A pilot study.</a> Plast Reconstr Surg Glob Open. 4 (12), e1038 (2016).</li><li>Kubiak, C. A., Kemp, S. W. P., Cederna, P. S., Kung, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prophylactic+regenerative+peripheral+nerve+interfaces+to+prevent+postamputation+pain.">Prophylactic regenerative peripheral nerve interfaces to prevent postamputation pain.</a> Plast Reconstr Surg. 144 (3), 421-430 (2019).</li><li>Hooper, R. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interfaces+for+the+management+of+symptomatic+hand+and+digital+neuromas.">Regenerative peripheral nerve interfaces for the management of symptomatic hand and digital neuromas.</a> Plast Reconstr Surg Glob Open. 8 (6), e2792 (2020).</li><li>Lee, J. C., Kumar, N. G., Kemp, S. W. P., Cederna, P. S., Kung, T. A. S. P. 0. 6. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interface+surgery+and+its+four-year+pain+and+medication+intake+outcomes+for+treatment+or+prevention+of+postamputation+pain.">Regenerative peripheral nerve interface surgery and its four-year pain and medication intake outcomes for treatment or prevention of postamputation pain.</a> Plast Reconstr Surg Glob Open. 11, 123-123 (2023).</li><li>Lin, Z., Yu, P., Chen, Z., Li, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Regenerative+peripheral+nerve+interface+reduces+the+incidence+of+neuroma+in+the+lower+limbs+after+amputation:+a+retrospective+study+based+on+ultrasound.">Regenerative peripheral nerve interface reduces the incidence of neuroma in the lower limbs after amputation: a retrospective study based on ultrasound.</a> J Orthop Surg Res. 18 (1), 619 (2023).</li><li>Mauch, J. T., Kao, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Targeted+muscle+reinnervation+and+regenerative+peripheral+nerve+interfaces+for+pain+prophylaxis+and+treatment+A+systematic+review.">Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment A systematic review.</a> PM R. 15 (11), 1457-1465 (2023).</li><li>Kurlander, D. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TMRpni:+Combining+two+peripheral+nerve+management+techniques.">TMRpni: Combining two peripheral nerve management techniques.</a> Plast Reconstr Surg Glob Open. 8 (10), e3132 (2020).</li><li>Zbinden, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improved+control+of+a+prosthetic+limb+by+surgically+creating+electro-neuromuscular+constructs+with+implanted+electrodes.">Improved control of a prosthetic limb by surgically creating electro-neuromuscular constructs with implanted electrodes.</a> Sci Transl Med. 15 (704), 3665 (2023).</li><li>Dellon, A. L., Aszmann, O. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+musculus,+veritas?+Nerve+&amp;#34;in+muscle&amp;#34;+versus+targeted+muscle+reinnervation+versus+regenerative+peripheral+nerve+interface:+Historical+review.">In musculus, veritas? Nerve &amp;#34;in muscle&amp;#34; versus targeted muscle reinnervation versus regenerative peripheral nerve interface: Historical review.</a> Microsurgery. 40 (4), 516-522 (2020).</li><li>Vu, P. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+regenerative+peripheral+nerve+interface+allows+real-time+control+of+an+artificial+hand+in+upper+limb+amputees.">A regenerative peripheral nerve interface allows real-time control of an artificial hand in upper limb amputees.</a> Sci Transl Med. 12 (533), 2857 (2020).</li><li>Vu, P. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+upper-extremity+prosthetic+control+using+regenerative+peripheral+nerve+interfaces+and+implanted+EMG+electrodes.">Long-term upper-extremity prosthetic control using regenerative peripheral nerve interfaces and implanted EMG electrodes.</a> J Neural Eng. 20 (2), 026039 (2023).</li><li>Ortiz-Catalan, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+higly+integrated+bionic+hand+with+neural+control+and+feedback+for+use+in+daily+life.">A higly integrated bionic hand with neural control and feedback for use in daily life.</a> Sci Robot. 8 (83), (2023).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% NaCl sterile solution</td>
			<td>Thermo Fisher Scientific</td>
			<td>Z1376</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
		<tr>
			<td>6-0 Ethilon suture</td>
			<td>Ethicon</td>
			<td>660H</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
		<tr>
			<td>Dissecting scissors</td>
			<td>Stille</td>
			<td>101-8172-23</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
		<tr>
			<td>Gauze</td>
			<td>M&#246;lnlycke</td>
			<td>152040</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
		<tr>
			<td>Loupes</td>
			<td>Zeiss</td>
			<td>Various</td>
			<td>User can choose loupes according to personal preferences.</td>
		</tr>
		<tr>
			<td>Nerve cutting set</td>
			<td>Checkpoint Surgical</td>
			<td>9250</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
		<tr>
			<td>Straight microscissors</td>
			<td>S&#38;T</td>
			<td>SAS-12 R-7</td>
			<td>The company and the catalog number is one example.&#160;</td>
		</tr>
	</tbody>
</table>

regenerative peripheral nerve interface: surgical protocol for a randomized controlled trial in postamputation pain

Chronic postamputation pain is a frequent occurrence following a major limb amputation1. Postamputation pain is a general term for unpleasant sensations that can manifest after amputation and is defined by the International Association for the Study of Pain as pain perceived in the residual limb (residual limb pain, RLP) or pain perceived in the missing extremity (phantom limb pain, PLP)2. The source of RLP is diverse and can stem from various causes, such as inflammation, infection, neuromas, heterotopic ossification, bursae, complex regional pain syndrome, and muscle and bone abnormalities3. For PLP, the precise origins remain incompletely elucidated, and it is thought to have a multifaceted etiology involving influences from both the peripheral and central nervous systems4,5.
When a peripheral nerve is injured, it will attempt to regenerate and reconnect with the relevant&#160;end organs6. In the situation of an amputation where the end organs are lost, abnormal sprouting of axons into surrounding scar tissue will take place and create a so-called neuroma7. The neuroma consists of a dense collagenous matrix where a disorganized tangle of axons, Schwann cells, endoneurial cells, and perineurial cells are trapped. Injured nociceptive fibers within the neuroma have a lower activation threshold, which results in the transmission of action potentials in the absence of external stimuli8. Furthermore, neuromas release inflammatory cytokines, which are associated with alterations in pain processing within the somatosensory cortex. This can lead to maladaptive changes in the central nervous system, further fueling the amplification and continuation of the neuropathic pain response9,10. There are complex and bidirectional interactions between the peripheral and central nervous systems that influence the chronification of pain. For example, individuals with sustained peripheral neuropathy might experience central sensitization, causing them to process new sensory input differently than those without chronic pain11. Painful neuromas are one of the known sources for both RLP and PLP; therefore, focusing on managing them is a crucial step toward minimizing the incidence and prevalence of postamputation pain.
Several surgical strategies have been suggested for the treatment and prevention of painful neuromas, and these strategies can generally be classified as reconstructive or non-reconstructive. Non-reconstructive methods commonly include excision of the neuroma without the intention for the severed nerve to reinnervate a physiologically appropriate target, such as nerve to bone or nerve to an already innervated muscle12. Whereas, reconstructive interventions are designed to facilitate the healthy, physiological regeneration of the donor nerve following neuroma excision. Several non-reconstructive methods include techniques such as nerve implantation within nearby tissue, nerve capping, applying proximal pressure, or using controlled thermal procedures on the distal nerve end13. One of the most common treatments is neuroma excision with implantation into nearby tissues such as muscle, bone, or vein14. However, according to neurophysiological principles, in all these aforementioned strategies, the freshly cut peripheral nerve will undergo axonal sprouting and elongation again. This process will likely result in the recurrence of the painful neuroma, as the regenerating axons will not have appropriate target end organs to reinnervate15. The outcomes of this technique have been diverse; some patients have experienced no, gradual, or full pain relief, while others have experienced pain relief shortly after surgical treatment but have developed pain after some time14,16. However, despite the fact that the technique has limited success in reducing pain, neuroma transposition with implantation and burying in muscle is still today widely used in amputation care and is, to a large extent, seen as the &#34;gold standard&#34; for surgical treatments of painful terminal neuromas12,17.
In the past decades, new developments in addressing painful neuromas have centered around a more proactive approach to treating the nerve ending after removing the neuroma, where the objective is to ensure the satisfaction of the nerve end and promote a more natural process of neuronal regeneration12,13. A novel intervention developed by Professor Paul Cederna&#39;s group at the University of Michigan, Ann Arbor, USA, is the regenerative peripheral nerve interface (RPNI). This technique includes excision of a neuroma, longitudinal dissection of the donor nerve stump into multiple fascicle groupings, and thereafter direct implantation of the fascicles into free denervated skeletal muscle grafts18,19. The implantation in devascularized, denervated muscle allows the nerve fascicles to reinnervate the free muscle graft after it revascularizes within its implanted wound bed20. Histological work has shown the innervation of free muscle grafts of different volumes; however, their viability and function have optimal dimensions21. Once the engrafted free muscle graft becomes revascularized and reinnervated, the RPNI thereby prevents the recurrence of painful neuromas. The procedure has been adopted in several clinics, mainly in the USA but also in places within Europe and Asia. However, this has given rise to variations in the procedure. Therefore, in this article, we propose a consensus on the technique among surgeons worldwide who practice it.
This article describes the step-by-step protocol for RPNI surgery, which is used in an international RCT (ClinicalTrials.gov, NCT05009394). The aim of this RCT is to assess the effectiveness of the two most used reconstructive techniques, RPNI and TMR, compared to the most used standard surgical treatment22. The purpose of this method paper is to standardize the technique for the centers involved in the RCT and to make the procedure available for everyone who would like to use it in amputation management.

<meta charset="utf8"></head><body>作者聚焦：截肢后疼痛管理中的再生周围神经接口 （RPNI） 手术

再生周围神经接口：截肢后疼痛随机对照试验的手术方案

Read this Scientific Article Protocol about Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain at JoVE.com

Surgical procedures, including nerve reconstruction and end-organ muscle reinnervation, have become more prominent in the prosthetic field over the past ...

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Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

974 次观看.  Center for Bionics and Pain Research. 我们正在研究治疗截肢后疼痛的外科手术。那就是残肢痛和幻肢痛。特别是，我们的目标是提供高质量的科学证据，证明外科手术的疗效，其中神经被赋予新的肌肉靶点以避免神经瘤和疼痛的形成。截肢的原因多种多样，而且这些往往是计划外发生的，例如外伤。这导致残肢的解剖结构存在很大差异。这种可变性对外科手术的标准化提出了挑战...

视频: 作者聚焦：截肢后疼痛管理中的再生周围神经接口 （RPNI） 手术

Surgical procedures, including nerve reconstruction and end-organ muscle reinnervation, have become more prominent in the prosthetic field over the past decade. Primarily developed to increase the functionality of prosthetic limbs, these surgical procedures have also been found to reduce postamputation neuropathic pain. Today, some of these procedures are performed more frequently for the management and prevention of postamputation pain than for prosthetic fitting, indicating a significant need for effective solutions to postamputation pain. One notable emerging procedure in this context is the Regenerative Peripheral Nerve Interface (RPNI). RPNI surgery involves an operative approach that entails splitting the nerve end longitudinally into its main fascicles and implanting these fascicles within&#160;free denervated and devascularized muscle grafts. The RPNI procedure takes a proactive stance in addressing freshly cut nerve endings, facilitating painful neuroma prevention and treatment by enabling the&#160;nerve to regenerate and innervate an end organ, i.e., the free muscle graft. Retrospective studies have shown RPNI&#39;s effectiveness in alleviating postamputation pain and preventing the formation of painful neuromas. The increasing frequency of utilization of this approach has also given rise to variations in the technique. This article aims to provide a step-by-step description of the RPNI procedure, which will serve as the standardized procedure employed in an international, randomized controlled trial (ClinicalTrials.gov, NCT05009394). In this trial, RPNI is compared to two other surgical procedures for postamputation pain management, specifically, Targeted Muscle Reinnervation (TMR) and neuroma excision coupled with intra-muscular transposition and burying.

Here, we describe the surgical procedure to perform Regenerative Peripheral Nerve Interface (RPNI) surgery for treating postamputation neuropathic pain in the context of an international, randomized controlled trial (RCT) (ClinicalTrials.gov, NCT05009394). The RCT compares RPNI with two other surgical techniques, namely, Targeted Muscle Reinnervation (TMR) and neuroma excision combined with intra-muscular transposition.

作者聚焦：截肢后疼痛管理中的再生周围神经接口 （RPNI） 手术

作者聚焦：截肢后疼痛管理中的再生周围神经接口（RPNI）手术