Regenerative Peripheral Nerve Interfaces (RPNI) for Neuroma and Phantom Limb Pain
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Neuroma pain and phantom limb pain remain major barriers to rehabilitation after amputation, while conventional approaches often provide only partial or temporary relief.
In this lecture, Dr. Paul Cederna presents regenerative peripheral nerve interface (RPNI) surgery as a physiologic strategy: instead of simply burying, ligating, or ablating an injured nerve, the nerve is provided with a denervated muscle target for reinnervation. He explains the biological rationale, demonstrates how muscle graft size and nerve caliber influence the procedure, and walks through RPNI applications in below-knee, above-knee, transradial and transhumeral amputations, as well as digital, intercostal, brachial plexus and other symptomatic neuromas.
The discussion goes beyond technique. Clinical cases illustrate pain reduction and prosthetic use after RPNI, while the Q&A explores prophylactic RPNI at the time of amputation, comparison with TMR, patient selection, diagnostic blocks, common technical errors, and the future of RPNI in reconstructive and battlefield surgery. A particularly practical section focuses on why an apparently simple muscle graft can fail when it is too thick or mismatched to the nerve.
In this lecture, Dr. Paul Cederna presents regenerative peripheral nerve interface (RPNI) surgery as a physiologic strategy: instead of simply burying, ligating, or ablating an injured nerve, the nerve is provided with a denervated muscle target for reinnervation. He explains the biological rationale, demonstrates how muscle graft size and nerve caliber influence the procedure, and walks through RPNI applications in below-knee, above-knee, transradial and transhumeral amputations, as well as digital, intercostal, brachial plexus and other symptomatic neuromas.
The discussion goes beyond technique. Clinical cases illustrate pain reduction and prosthetic use after RPNI, while the Q&A explores prophylactic RPNI at the time of amputation, comparison with TMR, patient selection, diagnostic blocks, common technical errors, and the future of RPNI in reconstructive and battlefield surgery. A particularly practical section focuses on why an apparently simple muscle graft can fail when it is too thick or mismatched to the nerve.
PRAS-03
Course
Lower Extremity Reconstruction: Limb Salvage, Wound Management, and Functional Outcomes
01
56:14
Chronic Wounds: From Etiology to Surgical ClosureA practical overview of chronic wound assessment, etiological diagnosis, wound-bed preparation, dressings, debridement and reconstructive options, with a focus on evidence-based decision-making.
02
1:05:42
Principles and Goals in Severe Limb Trauma ReconstructionHow do you decide when a severely injured limb should be salvaged—and when primary amputation is the better reconstruction? Dr Hari Venkatramani explores practical decision-making in mangled upper and lower extremities through complex clinical cases, microsurgical reconstruction, debridement, flap coverage and staged functional recovery.
03
1:03:15 Now playing
Regenerative Peripheral Nerve Interfaces (RPNI) for Neuroma and Phantom Limb PainWhy do neuromas keep returning after amputation, and can we give regenerating axons a better target? Dr. Paul Cederna explains the rationale behind RPNI, its technical principles, clinical results, and its growing role in both treatment and prevention of post-amputation pain.
04
48:10
Endovascular Revascularization and Free Flap Salvage of Diabetic Foot UlcersA practical case-based lecture on combining endovascular revascularization with free tissue transfer to salvage severely ischemic diabetic feet, with emphasis on timing, recipient vessels and flap selection.
05
1:48:07
Microsurgical Reconstruction of the Lower Extremity in a Level 1 Trauma CenterA case-based lecture on complex lower-extremity trauma, limb salvage, flap selection and microsurgical reconstruction, with a strong focus on function, vascular preservation and practical decision-making.
06
1:06:01
Lower Limb Reconstruction After High-Energy Trauma: Flaps, NPWT and Flap SalvageA practical overview of lower-limb reconstruction after complex trauma: choosing local and free flaps, using negative-pressure wound therapy, monitoring microsurgical flaps and recognizing vascular compromise before salvage becomes unlikely.
Regenerative Peripheral Nerve Interfaces (RPNI) for Neuroma and Phantom Limb Pain