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Page 8 of 10 Berberoglu et al. Plast Aesthet Res 2024;11:14 https://dx.doi.org/10.20517/2347-9264.2023.101

RPNIs are highly effective for the treatment and prevention of neuroma pain and PLP. They are also
effective in amplifying peripheral nerve action potentials to facilitate the recording of high-fidelity motor
control signals. To date, more than 200 patients with upper and lower extremity amputations underwent
[41]
RPNI surgery . However, they do not work in all cases, largely due to the need for revascularization of the
RPNI during the healing process. Anything that could potentially adversely impact the revascularization of
the RPNI may impact the full regeneration and reinnervation of the construct. Although no direct evidence
exists, relative contraindications for other soft tissue grafts, such as vascular disease, nutritional deficiency,
corticosteroid use, and immunosuppression, may also interfere with the RPNI maturation and
revascularization process . For this reason, RPNI is not performed on patients who are actively using
[46]
nicotine because this will adversely impact the revascularization and regeneration of the RPNI [47,48] . When
RPNI is performed in a poorly vascularized bed, such as a significantly scarred or radiated field, full
regeneration or reinnervation may also not be achieved due to compromised revascularization . Lastly, it is
[49]
not recommended to perform RPNIs in contaminated fields, as this may also impact the viability of the
RPNI over time.

CONCLUSION
An ideal prosthetic interface would provide bidirectional motor control and sensory feedback. RPNI
provides high amplitude and reliable signals for improved motor control and the DS-RPNI has the potential
to restore sensory feedback in individuals to allow a more functional and intuitive prosthetic device
experience. The C-RPNI is a potential solution when applications of the RPNI and DS-RPNI as separate
constructs are limited, including proximal transhumeral amputations. RPNI’s indications continue to
expand as this technique can be applied to any transected or continuous peripheral nerve to serve as a
biologically stable bioamplifier of efferent motor action potentials. The MC-RPNI is a promising neural
interface to control advanced exoskeleton devices for individuals with musculoskeletal injuries. The future
of these novel surgical innovative approaches will allow individuals to be able to feel and manipulate objects
similar to using their native limbs and would have a much more naturalistic and intuitive experience.

DECLARATIONS
Acknowledgments
We thank Widya Adidharma and Sara Huang for providing surgical images and illustrations.

Authors’ contributions
Performed writing of the manuscript: Berberoglu I, Burke KL
Assisted with manuscript preparation: Kemp SWP, Cederna PS

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Dr. Paul Cederna is the president of Blue Arbor Technologies, a company which makes hardware and
software to control prosthetic devices. However, none of the proprietary hardware or software offerings of
the company are discussed in this paper. In addition, products of Blue Arbor Technologies are not yet
available for sale on the market. All other authors declared that there are no conflicts of interest.