When an amputation is necessary, addressing the nerves at the same time — with RPNI or TMR — prevents the neuromas and phantom pain that otherwise develop, and sets the stage for advanced prosthetic control.
Pain at the source
At amputation
Prosthetic future
Traditional amputation leaves cut nerves to form painful neuromas, a leading cause of residual and phantom pain. A nerve-optimized amputation manages every divided nerve at the time of surgery using RPNI or TMR, giving each nerve a healthy endpoint before pain can develop.
This proactive approach dramatically reduces future pain, improves prosthetic tolerance, and creates clean control signals for advanced myoelectric and bionic limbs.
Fig: Left untreated, a cut nerve forms an end-bulb neuroma — exactly what nerve-optimized amputation prevents.
Elective or scheduled amputations where nerves can be managed proactively.
Acute amputations where nerve handling sets up a better recovery.
Patients seeking the best foundation for advanced prosthetic control.
Every nerve to be divided is identified for RPNI or TMR.
The amputation is performed with meticulous nerve handling.
Each nerve receives an RPNI or TMR to give it a healthy endpoint.
Healing and prosthetic fitting proceed on a pain-minimized foundation.
Peripheral nerve surgery is its own discipline. Dr. Michaeli has dedicated his practice to the nerves, with fellowship-level training and thousands of nerve procedures.
Nerve work is measured in millimeters. Every repair is performed under high-magnification with microsurgical instruments and the latest reconstructive techniques.
Many patients arrive having been told nothing more can be done. A dedicated nerve evaluation often reveals options that general specialists do not offer.
The limb heals with the nerves already managed.
Nerve endpoints mature, keeping pain low.
Prosthetic fitting and signal use advance on a stable base.
Peripheral Nerve & Brachial Plexus Surgeon · New Jersey & New York
Dr. Michaeli is among the most experienced and trusted peripheral nerve specialists on the East Coast, combining board-certified hand surgery expertise with dedicated peripheral nerve training. He has helped patients across the region regain function when they were told nothing more could be done.
Most peripheral nerve procedures are medically necessary and covered by insurance. Our team will help you understand your benefits and assemble the documentation your plan requires.
Why managing the nerves during amputation prevents pain and improves the prosthetic future.
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“After years of being told my pain was something I’d have to live with, Dr. Michaeli found the nerve causing it and fixed it.”
Neuroma surgery
“I had given up hope of using my hand again. The nerve transfer gave me back movement the other doctors said was gone.”
Nerve transfer
“The carpal tunnel release was quick and the night pain was gone immediately. I only wish I’d done it sooner.”
Carpal tunnel release
Schedule a consultation with Dr. Michaeli to understand your options and build a plan that fits your life.
