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Figure 5. Illustration of the regenerative peripheral nerve interface approach. A tibial neuroma is resected, followed by anastomosis of
the proximal nerve end with a skeletal muscle graft, most likely taken from the vastus lateralis muscle. Skeletal muscle fibers are
fastened parallel to the nerve fibers and buried deep underneath the adjacent muscles of the leg. Illustrated by Seitz AJ.
Figure 6. (left) Recurrent symptomatic neuroma of sciatic nerve following TMR surgery (same patient as Figure 4). (right) Patient
undergoing reoperation with regenerative peripheral nerve interface following resection of recurrent sciatic nerve neuroma. Skeletal
muscle graft fastened and wrapped around the nerve ending prior to deep muscle burial of RPNI. Photo credit to Dr. Poore SO. TMR:
Targeted muscle reinnervation; RPNI: regenerative peripheral nerve interface.
of symptomatic neuroma formation with the RPNI approach . These promising preclinical studies
[31]
propelled the use of the RPNI approach in human patients starting in 2013 at the University of Michigan,
with over 250 patients receiving this treatment since then .
[28]
