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Burke et al. Plast Aesthet Res 2022;9:48 Plastic and
DOI: 10.20517/2347-9264.2022.26
Aesthetic Research

Review Open Access

Regenerative peripheral nerve interfaces (RPNIs):
current status and future direction

1
1,2
1
1
Katherine L. Burke , Theodore A. Kung , Rachel C. Hooper , Stephen W. P. Kemp , Paul S. Cederna 1,2
1
Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109-0340, USA.
2
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109-0340, USA.
Correspondence to: Dr. Paul S. Cederna, Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130
Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA. E-mail: cederna@med.umich.edu
How to cite this article: Burke KL, Kung TA, Hooper RC, Kemp SWP, Cederna PS. Regenerative peripheral nerve interfaces
(RPNIs): current status and future direction. Plast Aesthet Res 2022;9:48. https://dx.doi.org/10.20517/2347-9264.2022.26
Received: 13 Mar 2022 First Decision: 6 May 2022 Revised: 4 Jun 2022 Accepted: 9 Aug 2022 Published: 17 Aug 2022

Academic Editors: Joseph M. Rosen, Matthew L. Iorio Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
Despite significant advancements in neuroprosthetic control strategies, current peripheral nerve interfacing
techniques are limited in their ability to facilitate accurate and reliable long-term control. The regenerative
peripheral nerve interface (RPNI) is a biologically stable bioamplifier of efferent motor action potentials with
demonstrated long-term stability. This innovative, straightforward, and reproducible surgical technique has shown
enormous potential in improving prosthetic control for individuals with upper limb amputations. The RPNI consists
of an autologous free muscle graft secured around the end of a transected peripheral nerve or individual fascicles
within a residual limb. This construct facilitates EMG signal transduction from the residual peripheral nerve to a
neuroprosthetic device using indwelling bipolar electrodes on the muscle surface. This review article focuses on the
development of the RPNI and its use for intuitive and enhanced prosthetic control and sensory feedback. In
addition, this article also highlights the use of RPNIs for the prevention and treatment of postamputation pain.

Keywords: Prosthetic control, amputation, RPNI, regenerative peripheral nerve interface, neuroma, sensory
feedback

INTRODUCTION
Upper limb loss has devastating functional consequences as well as a substantial impact on an individual’s

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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