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IRCCS Istituto Ortopedico Rizzoli

2 ARTICLES PUBLISHED IN JoVE

Medicine

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

Emily Pettersen^1,2,3,4, Paolo Sassu⁵, Francesca Alice Pedrini^1,5, Hannes Granberg^1,2, Carina Reinholdt^2,6, Juan Manuel Breyer⁷, Aidan Roche⁸, Andrew Hart^9,10, Adil Ladak¹¹, Hollie A. Power¹¹, Michael Leung¹², Michael Lo¹², Ian Valerio¹³, Kyle R. Eberlin¹³, Jason Ko¹⁴, Gregory A. Dumanian¹⁴, Theodore A. Kung¹⁵, Paul Cederna¹⁵, Max Ortiz-Catalan^1,4,16,17

¹Center for Bionics and Pain Research, ²Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, ³Department of Electrical Engineering, Chalmers University of Technology, ⁴Bionics Institute, ⁵IV Clinica Ortoplastica, IRCCS Istituto Ortopedico Rizzoli, ⁶Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, ⁷Department of Orthopedic Surgery, Hand Unit, Worker Hospital, ⁸College of Medicine and Veterinary Medicine, The Queen's Medical Research Institute, The University of Edinburgh, ⁹Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, ¹⁰College of Medicine, Veterinary & Life Sciences, The University of Glasgow, ¹¹Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, ¹²Plastics and Reconstructive Surgery, Dandenong Hospital, Monash Health, ¹³Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital & Harvard Medical School, ¹⁴Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, ¹⁵Section of Plastic Surgery, Department of Surgery, Michigan Medicine, ¹⁶Medical Bionics Department, University of Melbourne, ¹⁷Prometei Pain Rehabilitation Center

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.

Medicine

Targeted Muscle Reinnervation: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain

Emily Pettersen^1,2,3,4, Paolo Sassu⁵, Francesca Alice Pedrini^1,5, Hannes Granberg^1,2, Carina Reinholdt^2,6, Juan Manuel Breyer⁷, Aidan Roche⁸, Andrew Hart^9,10, Adil Ladak¹¹, Hollie A. Power¹¹, Michael Leung¹², Michael Lo¹², Ian Valerio¹³, Kyle R. Eberlin¹³, Theodore A. Kung¹⁴, Paul Cederna¹⁴, Jason M. Souza^15,16, Oskar Aszmann¹⁷, Jason Ko¹⁸, Gregory A. Dumanian¹⁸, Max Ortiz-Catalan^1,4,19,20

¹Center for Bionics and Pain Research, ²Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, ³Department of Electrical Engineering, Chalmers University of Technology, ⁴Bionics Institute, ⁵IV Clinica Ortoplastica, IRCCS Istituto Ortopedico Rizzoli, ⁶Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, ⁷Department of Orthopedic, Hand Unit, Worker Hospital, ⁸College of Medicine and Veterinary Medicine, The Queen's Medical Research Institute, The University of Edinburgh, ⁹Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, ¹⁰College of Medicine, Veterinary & Life Sciences, The University of Glasgow, ¹¹Division of Plastic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, ¹²Plastics and Reconstructive Surgery, Dandenong Hospital, Monash Health, ¹³Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital &, Harvard Medical School, ¹⁴Section of Plastic Surgery, Department of Surgery, Michigan Medicine, ¹⁵Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, ¹⁶Department of Plastic and Reconstructive Surgery, Ohio State University, ¹⁷Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Vienna, ¹⁸Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, ¹⁹Medical Bionics Department, University of Melbourne, ²⁰Prometei Pain Rehabilitation Center

The protocol outlines the surgical procedure for the treatment of postamputation pain using Targeted Muscle Reinnervation (TMR). TMR will be compared with two other surgical techniques, specifically Regenerative Peripheral Nerve Interface (RPNI) and neuroma excision, followed by immediate burying within muscle under the context of an international, randomized controlled trial.