American Society for Peripheral Nerve (ASPN)
Spring 2020

The Synapse editorial team members are thinking of all of you during these chaotic and uncertain times. We wish you much health, and we hope that this newsletter provides you a little bit of joy. Please take care of yourselves and one another. We’re all in this together, and together we can make an impact on tomorrow!

ASPN President, Chris Novak
Dr. Stephen Kemp
We had another successful and productive meeting in Ft. Lauderdale January 10-12, in collaboration with AAHS and ASRM. Thank you to our nearly 250 attendees; Chris Novak, ASPN President; and Amy Moore, ASPN Program Chair; who all contributed to the meeting’s success! The educational program was phenomenal, with instructional courses covering topics from nerve transfers, pain management, end-to-side neurorrhaphies, and yoga to headache management, thoracic outlet decompression, and rehab protocols. Invited speaker, Scott Kozin, MD, summarized his experience with nerve transfers for management of children with acute flaccid myelitis. Read More

Huge congratulations to our Awardees from the 2020 Annual Meeting!!!!!

Jana Dengler, MD
Range of independence with feeding, bladder management and transfers by motor level in cervical-level spinal cord injury
Washington University School of Medicine, St Louis, MO

Shelby Svientek, MD
Regenerative peripheral nerve interface (RPNI) treatment in rats alleviates chronic neuropathic pain hypersensitivity in a sexually dimorphic manner
The University of Michigan, Ann Arbor, Michigan

Grace Catherine Keane, MD
Intra-operative electrical stimulation of non-neuronal cells can improve nerve regeneration across short isografts in a rat model
Washington University in Saint Louis School of Medicine, Saint Louis, MO,

Zarina S Ali, MD, MS
Tissue engineered nerve grafts facilitate muscle reinnervation following long gap facial nerve injury in swine
University of Pennsylvania, Philadelphia, PA

Gregory Borschel, MD
Dear ASPN Members and Colleagues:

On behalf of the ASPN Executive Council, I hope that the members of our Society are well and that their families and friends are safe. We are in unprecedented times as the COVID-19 pandemic has presented us with challenges and disruptions unlike anything we have ever seen. While we are in a period of uncertainty, there are some helpful resources made available through our affiliate societies specific for surgeons and healthcare professionals. Read More

Theodore Kung, MD
Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain.
Carrie A. Kubiak MD, Stephen W.P. Kemp PhD, Paul S. Cederna MD, Theodore A. Kung MD
Plastic and Reconstructive Surgery. 2019; 144(3): 421-430e.
From the Department of Surgery, Section of Plastic and Reconstructive Surgery, and the Department of Biomedical Engineering, University of Michigan.

Q&A with ASPN member Theodore Kung, MD:
1. What is the take home message of your study?
Regenerative Peripheral Nerve Interfaces (RPNIs) are a novel way to leverage the biologic processes of nerve regeneration and muscle reinnervation to reduce the incidence of neuroma formation. In this manner, RPNIs can reduce the number of aimless axons within the residual limb after amputation and therefore mitigate the development of postamputation pain. Read More

Did you know? Don't confuse your Bands!

Two types of bands are integral to nerves and are distinct—but commonly confused—entities. One is an anatomical phenomenon, while the other is only present during regeneration. Did you know which is which???

The Bands of Fontana are oblique and transverse lines seen along nerves, related to undulating, repeating structures within both the perineurium and endoneurium. These bands were first described in 1779 by anatomist Felice Fontana, who was the first to suggest their presence is related to the nerve’s ability to tolerate stretching.

The Bands of Bungner, on the other hand, guide regenerating axons after a nerve injury. They are formed when proliferating Schwann cells and remaining basement membrane form endoneurial tubes. These tubes of interdigitating Schwann cells and basal lamina guide regenerating axons.

Well there you have it. Keep those bands straight… or maybe redundant, depending on the context!

Travis Miller

Damian Palafox

Blair Peters

Lukas Rasulic

Travis Miller, MD
Stanford Hospitals and Clinics
Palo Alto, California

Damian Palafox, MD
Hospital Angeles Puebla
Puebla, Mexico

Blair Peters, MD
Washington University
Saint Louis, MO

Prof. Dr. Lukas Rasulic
Clinic for Neurosurgery
Clinical Center of Serbia
Belgrade, Serbia
Read more

Noah Raizman, MD
provided by Noah Raizman

Upcoming Changes to E&M Coding Will Affect All Peripheral Nerve Surgeons
Evaluation and Management (E&M) codes cover office visits, consults and emergency room visits and are tied to a significant amount of physician revenue. While electronic health records systems (EHR) have allowed some simplification of the tedious and complicated process of assigning a proper code to office visits, physicians have long been forced to jump through multiple documentation hoops to achieve a specific code level or else face the possibility of denials or claw-backs. Read More

A few snippets from the 2013 annual meeting in Naples, FL…
View larger photos

Upcoming meetings around the globe

As with many upcoming meetings, the Facial Paralysis Reconstruction Course in Chang Gung, originally scheduled for April 2020, has been postponed and will be rescheduled at a later date… potentially in late 2020.

Penny for your thoughts?

Thank you to everyone who responded to the "Penny for your thoughts" in Issue 3. Results are depicted in the graphs below:

1) Does your institution currently offer a dedicated,
separate nerve fellowship?

2) Do you think dedicated nerve fellowships should
be more numerous?

1) Does your institution currently offer a dedicated,
separate nerve fellowship?
2) Do you think dedicated nerve fellowships should
be more numerous?

Now for the next figurative penny...

1) Do you treat patients with acute flaccid myelitis (AFM)?
2) I am comfortable performing the following surgical reconstruction in patients with AFM. (select all that apply)
Upper extremity
Lower extremity
Results will be shared in the next issue of Synapse!

Show me the money... research money!

Do you have great ideas? Do you love science? Well, then get your projects funded!!! Translate your ideas to projects! Create data to help us all! The ASPN Grants Committee has compiled valuable information to help fund your nerve-related science... follow the link to learn more! #scienceiscool

See the ASPN list of peripheral nerve funding sources!

Meet some new, familiar faces!

Here they are... your fearless 2020 ASPN Executive Council