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Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers
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Access to Reconstructive Plastic Surgery and Nerve Procedures in Lower Extremity Amputations.
Jennifer Krupa Shah1,2, Daniel Najafali3, Devi Lakhlani4
1Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States.
Journal of Reconstructive Microsurgery
|February 23, 2026
Summary
Neuroma prevention during lower extremity amputation is rare but more common in facilities with higher plastic surgery volume. Access to plastic surgery services impacts the use of nerve procedures to prevent neuroma after amputation.
Area of Science:
- Surgical outcomes
- Health services research
- Amputation care
Background:
- Neuroma is a common complication following lower extremity amputations, leading to significant patient morbidity.
- Understanding factors influencing preventative procedures is crucial for improving amputation care.
- This study investigates the link between plastic surgery access and the utilization of nerve procedures during amputation.
Purpose of the Study:
- To determine the association between plastic surgery volume at facilities and the incidence of nerve procedures during lower extremity amputations.
- To analyze demographic and socioeconomic factors influencing the likelihood of receiving concurrent nerve procedures.
- To examine trends in lower extremity amputation and associated nerve procedures over a six-year period.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2016-2021.
- Identified lower extremity amputations and concurrent nerve procedures (targeted muscle reinnervation, regenerative peripheral nerve interface) using ICD-10 codes.
- Assessed plastic surgery volume via ICD-10-PCS codes and employed regression models to analyze outcomes.
Main Results:
- Only 0.6% of 245,170 lower extremity amputations included concurrent nerve procedures.
- Higher amputation incidence was linked to greater comorbidity burden and Black and Native American race.
- Facilities with higher plastic surgery volume demonstrated significantly higher nerve procedure incidence (IRR 21.949, p<0.001).
Conclusions:
- Increasing plastic surgery volume at a facility is strongly associated with a higher incidence of nerve procedures during lower extremity amputations.
- While overall amputation rates remained stable, disparities in incidence and procedure utilization were observed across racial and socioeconomic groups.
- Enhanced access to plastic surgery services may improve the implementation of neuroma-preventing procedures in amputation care.
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