Limb Reconstruction Program prevents nerve pain before it starts. 

For many people who have lost a limb or are at risk of losing one, chronic nerve pain is a constant companion. As they work to regain their mobility and reclaim their lives, they must simultaneously contend with daily discomfort caused by nerve injury. Studies show up to 95% of amputees demonstrate either residual limb pain, phantom limb pain or both—neuropathic symptoms that may significantly decrease their quality of life. 

Leading experts with the Cedars-Sinai Limb Reconstruction Program are changing the calculus—utilizing novel surgical techniques to reduce or even prevent nerve pain before it starts. 

“At Cedars-Sinai, we specialize in innovative nerve surgeries that enable patients to resume activities they enjoy,” said Meghan McCullough, MD, a plastic and reconstructive surgeon with a specialty in hand and upper-extremity surgery. “These procedures can be absolute game-changers.” 

Transforming Outcomes: TMR and RPNI

Nerve damage following amputation or injury typically results in a neuroma—a disorganized growth, or tumor, of nerve tissue that develops when a nerve ending is disconnected from its target organ. End neuromas occur in all patients following amputation. 

Many of these patients can benefit from a procedure known as targeted muscle reinnervation (TMR), in which cut nerves are rerouted to connect to other nerves that attach to muscles. A severed nerve is similar to a live electrical wire; through TMR, surgeons reconnect that live wire to help complete the circuit, potentially resolving any misfires and reducing neuroma and phantom limb pain. 

Regenerative peripheral nerve interface (RPNI) is another approach, in which surgeons implant a cut nerve into a small muscle graft, providing the nerve with a new target that will allow it to regenerate in an organized fashion. 

“TMR and RPNI are two sides of the same coin, treating the nerves and giving them a way to avoid pathologic change,” said Justin Koh, MD, an orthopedic surgeon with Cedars-Sinai’s Limb Reconstruction Program. “The resulting decrease in chronic nerve pain can be substantial.” 

The Proof in the Pudding

Over the last decade, studies have shown clear benefits of both TMR and RPNI, and a recent case treated at Cedars-Sinai bears out the data. 

Fifteen-year-old Audrey suffered a traumatic injury in 2024 while on vacation in New Mexico. She had a compound fracture of her tibia and fibula, as well as a complicated fracture in her calcaneus (heel) bone. Fortunately, she was able to avoid an amputation, but the nerve pain was excruciating. 

“You could touch Audrey’s foot with a feather, and she would feel it,” recalled her dad, Chris. “The pain hampered her ability to function, but the surgery at Cedars-Sinai was incredible. It took away her pain completely, and she now has full mobile control of her leg.” 

As Chris sees it, Cedars-Sinai’s surgeons did more than just restore Audrey’s mobility; they also helped her reclaim her future. 

“After her accident, of course my first thought was, ‘Thank God she’s alive,’ but then you confront the questions about how your child is going to cope with a life-changing injury,” Chris said. “What these doctors did was give Audrey her long-term quality of life back. It’s a real testament to people in their profession who actually care about their patients and are at the top of their game.” 

A Path to Less Pain

Resolving nerve pain is an evolving science, noted Geoffrey Marecek, MD, director of the Limb Reconstruction Program, but Cedars-Sinai is at the head of the curve. 

 “We’re the only program of our kind on the West Coast, and people come see us from across the country,” he said. “It’s a privilege to help alleviate their pain and put them on a path to a better quality of life.” 

CedarsSinai’s Limb Reconstruction Program is a vital source of support for patients who are at risk of losing a limb or who have had an amputation.