Page 68 - Read Online

Sears et al. Plast Aesthet Res 2024;11:31 Plastic and
DOI: 10.20517/2347-9264.2024.04
Aesthetic Research

Opinion Open Access

Innovating innervation: how non-biological targets
can revolutionize amputation care

Lucas A. Sears, D’Andrea T. Donnelly, Weifeng Zeng, Aaron M. Dingle

Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
53792, USA.
Correspondence to: Dr. Aaron M. Dingle, Division of Plastic and Reconstructive Surgery, University of Wisconsin School of
Medicine and Public Health, 600 Highland Avenue, CSC-G5/361, Madison, WI 53792, USA. E-mail: dingle@surgery.wisc.edu
How to cite this article: Sears LA, Donnelly DT, Zeng W, Dingle AM. Innovating innervation: how non-biological targets can
revolutionize amputation care. Plast Aesthet Res 2024;11:31. https://dx.doi.org/10.20517/2347-9264.2024.04
Received: 4 Jan 2024 First Decision: 3 Jun 2024 Revised: 8 Jul 2024 Accepted: 25 Jul 2024 Available Online: 27 Jul 2024

Academic Editor: Godard de Ruiter Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
Amputation is a historically well-grounded procedure, but such a traumatic operation invites a litany of
postoperative complications, such as the formation of agonizing neuromas. Developments in mitigating these
complications include the clinically successful targeted muscle reinnervation (TMR) and regenerative peripheral
nerve interface (RPNI), which showcased the potential for utilizing peripheral nerves' regenerative capabilities to
circumvent neuroma formation and isolate neural activity for control of a sophisticated prosthetic device.
Nevertheless, these techniques only record the aforementioned neural activity from the reinnervated muscle, not
the nerve itself, which may ultimately limit the degree of functionality they can restore to amputees. Alternatively,
regenerative sieve electrodes are non-biological end targets for reinnervation that utilize their porous structure to
isolate regenerating axons into discrete transient zones lined with stimulating and recording electrodes. Albeit
more invasive, such direct contact with the once-damaged nerve opens the door for highly selective, bi-directional
neural interfaces with the capacity to restore higher degrees of sensorimotor functionality to patients for enhanced
rehabilitation outcomes. By expanding the definition of innervation to include non-biological targets, clinicians can
make room for these advancements in neural interfacing to revolutionize patient care.

INTRODUCTION
The amputation of a limb represents one of the oldest surgical procedures in medical history. In recent
years, rapid advances in biomechanics and prosthetic technology have ushered in a new era of innovation
for amputation procedures . We have seen a paradigm shift from a focus on limb salvage to limb
[1]

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/par