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Comparison of Reoperation and Complication Rates Between Acute and Delayed Advanced Nerve Interface Procedures in

Kevin Kuan-I Lee1, Omer Sadeh1, Alberto Barrientos1

  • 1Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, NY 10016, USA.

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|January 28, 2026
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Summary

Comparing acute versus delayed advanced nerve interface procedures for lower-extremity amputees, this study found early interventions had higher complication rates. Delayed procedures showed more symptomatic neuromas, highlighting patient factors over timing alone.

Keywords:
lower-extremity amputationpostoperative complicationsregenerative peripheral nerve interfacesurgical timingtargeted muscle reinnervation

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Area of Science:

  • Regenerative Medicine
  • Neurosurgery
  • Amputation Reconstruction

Background:

  • Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) procedures aid post-amputation pain and neuroma prevention.
  • Optimal timing for these advanced nerve interface procedures remains under investigation.

Purpose of the Study:

  • To compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees.
  • To identify factors influencing surgical outcomes in nerve interface reconstruction.

Main Methods:

  • Retrospective cohort study of 74 lower-extremity amputees undergoing TMR and/or RPNI (2019-2025).
  • Procedures classified as acute (concurrent with amputation/early reconstruction) or delayed (>1 month post-amputation).
  • Primary outcome: postoperative surgical complications within one year; statistical analyses included Mann-Whitney U, chi-square, and logistic regression.

Main Results:

  • Acute procedures (n=47) had higher one-year complication rates (23.4%) than delayed procedures (n=33, 12.1%).
  • Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions.
  • Early procedures showed higher odds of complications, but associations lacked statistical significance due to baseline patient differences.

Conclusions:

  • Early advanced nerve interface procedures were associated with higher complication rates, often in medically complex patients.
  • Delayed procedures showed a higher incidence of recurrent symptomatic neuromas.
  • Patient selection, amputation etiology, and surgical context are crucial, rather than timing alone, for optimal nerve interface reconstruction.