An advanced refinement of RPNI in which the muscle graft keeps its own blood supply — improving graft survival and the reliability of nerve reinnervation.
Muscle graft
Graft survival
Technique
VRPNI builds on the RPNI concept by using a muscle graft that retains its own vascular pedicle — its blood supply. A living, perfused graft survives more reliably and provides an even more robust target for the regenerating nerve.
This refinement is particularly valuable in larger nerves and in settings where graft survival is a concern, extending the benefits of RPNI to more complex reconstructions.
Fig: A vascularized RPNI: the muscle graft retains its blood supply (vascular pedicle) for more reliable survival.
Where a robust, well-perfused target improves reinnervation.
When graft survival must be maximized in a demanding repair.
After prior surgery where tissue quality is a consideration.
A muscle graft with a reliable blood supply is identified.
The vascularized graft is raised, preserving its perfusion.
The nerve is set into the living graft and secured.
The well-perfused graft supports robust nerve reinnervation.
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 vascularized graft heals with its blood supply intact.
Fibers grow into the living muscle, reducing pain signals.
Durable pain relief and signal stability develop.
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 a vascularized muscle graft can improve the reliability of nerve reinnervation.
A short explainer video from Dr. Michaeli will appear here. Replace the poster with your YouTube or Vimeo embed when ready.
“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.
