Parkland offers innovative surgery to reduce post-amputation pain

Posted: 11/16/2020

Regenerative peripheral nerve interface relieves neuroma symptoms

Surgeons at Parkland Health & Hospital System for the first time have performed a novel procedure to benefit patients experiencing painful neuromas caused by limb amputation, phantom pain and specific peripheral nerve pain resulting from injury, surgery and disease. Known as regenerative peripheral nerve interface (RPNI), the surgery has proven effective in treating and preventing neuroma pain. 

Also referred to as a pinched nerve or nerve tumor, a neuroma can be an extremely painful condition, frequently experienced in the region of the scar after amputation of a limb. According to the Journal of American Medicine, “Symptomatic neuromas significantly complicate the management of postoperative pain after major limb amputation. In patients who have undergone amputation, the incidence of painful neuroma is as high as 50% to 80%.”

A leading cause of amputations both nationally and at Parkland is diabetes, which has more than 35,000 active patients diagnosed with diabetes. The number of people living with diabetes in Dallas, currently estimated at 11.4% of the population, exceeds the national average of 10.5% 

“Patients with diabetes will greatly benefit from this procedure at the time of their amputation,” said Benjamin Levi, MD, a Parkland surgeon and Chief of General Surgery and Associate Professor of Surgery at UT Southwestern Medical Center. “I think this technique will be extremely helpful for our patients with chronic neuromas, phantom pain and those undergoing amputations.”

Dr. Levi, assisted by Preston Hewgley, MD, performed the first RPNI at Parkland or UT Southwestern on Sept. 24, 2020 and believes it to be the first performed in the North Texas area. RPNI was originally developed by Dr. Paul Cederna at the University of Michigan to help preserve residual peripheral nerve signals to control a neuroprosthetic device such as an artificial hand. Physicians later found that RPNI can also be used to treat symptomatic neuroma or can be performed at the time of limb amputation to prevent neuroma.

The new surgical technique involves implanting the divided end of a peripheral nerve into a free muscle graft to mitigate neuroma formation. It is estimated there are more than 2.1 million people living with limb loss in the U.S., a number expected to double by 2050. About 185,000 people have an amputation each year. 

Dr. Levi noted that RPNI implantation is “efficient and effective” and requires no additional costs in equipment and minimal additional time and resources. “We’re excited that we can now offer a treatment that has great potential to reduce postamputation pain after limb loss. RPNI is a reliable prevention and treatment of postamputation neuroma that will result in better outcomes for our patients.”