Grants Funded

Abstract

Project Summary: Each year, more than 100,000 amputations of the lower limb are performed on individuals with diabetes. Thirty percent of these patients are unable to use their prosthesis because of painful (i.e. symptomatic) neuromas or painful residual limbs. We aim to better understand and find ways to prevent painful nerve complications in diabetic patients who undergo these amputations. Currently, there are no clear guidelines to predict which patient is at risk for these complications. One important factor seems to be how well a diabetic patient controls their glucose levels. Therefore, we will evaluate how glucose control impacts the development of these debilitating neuromas. The main goals of this study are (i) to validate a model of symptomatic neuromas in diabetic rats to study neuroma development and (ii) to examine how glucose control affects the development of symptomatic neuromas in these rats. For the first goal, we will perform nerve surgery on diabetic rats to induce the formation of neuromas. We will then monitor the rats to see when and how often these symptomatic neuromas develop. We will monitor for signs of pain and correlate this to nerve and muscle tissue. For the second goal, we will compare diabetic rats with well-controlled glucose levels to diabetic rats with poorly controlled levels. We will assess the incidence of symptomatic neuromas and study any pain-related behavior in these rats. Again, we will analyze nerve and muscle tissue to help link glucose control to the development of symptomatic neuromas. In summary, this study seeks to understand when diabetic rats will develop painful neuromas after amputations and how blood glucose control may play a role in this process. The ultimate aim is to identify animals at risk and improve the management of these symptomatic neuromas. This pilot data will help us evaluate prevention treatments, such as targeted muscle reinnervation, in the future and eventually translate these findings to diabetic individuals.

Impact Statement: This study aims to understand the mechanism of action of developing painful neuromas (i.e. symptomatic neuromas) in diabetic individuals with limb amputations. Validating a rat model for symptomatic neuromas and investigating the impact of glucose control could identify at-risk animals. Understanding this link may shape tailored interventions including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI), potentially providing individualized treatments for diabetic amputees in the future.

Biography
I am the Division Chief of Plastic and Reconstructive Surgery at Rutgers New Jersey Medical School. For the past 14 years I have performed complex reconstructive surgery including oncologic reconstruction and breast reconstruction. I am also the residency program director as well as medical student clerkship director. I have trained approximately thirty residents and mentored approximately forty medical students. I have received awards for education and research both locally and nationally. I have been a strong advocate for diversity, equity, and inclusion at the medical school as well as in my medical practice. I have incorporated students and residents in this proposal to help increase awareness of the need for breast reconstruction and to improve the documented outcomes in Newark. In my clinical practice, I am dedicated to help provide treatment to lower limb amputee patients including targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) to prevent and treat neuroma pain. Since 2012, our plastic surgery clinic has evaluated over 600 limb amputee patients and provides surgical treatment for amputees with nerve pain in approximately 50 patients per year. Furthermore, our department closely collaborates with the Hanger Clinic, which provides prosthetic care and control for limb amputees.