• SengerJenna-Lynn BJBDepartment 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, Aline Thorkelsson, Shirley Duia, Ralph Hsiao, Stephen W P Kemp, Gustavo Tenorio, Mithun Rajshekar, Bradley J Kerr, K Ming Chan, Karyne N Rabey, and Christine A Webber.
• Department of Surgery, Division of Anatomy, University of Alberta, Edmonton , AB , Canada.
• Neurosurgery. 2023 Nov 1; 93 (5): 118011911180-1191.

Background And ObjectivesTargeted 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.MethodsThe 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.ResultsTen 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.ConclusionRPNI 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.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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