Professor Al Muderis performs a stump refashioning on an adult female Osseointegration patient. Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interface (RPNI) are also performed to reduce the risk of nerve pain by reinnervating the nerves to different muscles.
RPNI is a surgical technique that involves implanting the divided end of a peripheral nerve into a free muscle graft for the purposes of mitigating neuroma formation and facilitating prosthetic limb control. It involves the transected proximal nerve stump being inserted into a denervated muscle cuff, thus allowing for targeted axonal ingrowth.
TMR is a procedure performed in patients who undergo limb amputation or in patients with painful neuromas after nerve injury. When a nerve is injured or severed, it attemps to regenerate itself. If the nerve does not have a clear target toward which to regenerate, this process may result in a disorganized mass of nerve tissue called a neuroma which can cause pain.
TMR surgery involves rerouting severed or injured nerves to new muscle targets using microsurgical techniques to provide the nerve endings with a new muscle to innervate.
The new muscle targeted by the surgery encourages the nerve to regenerate in an organized fashion, rather than disorganized regeneration that can lead to neuroma formation and chronic pain.
Surgery performed at Macquarie University Hospital in Sydney, Australia.
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