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Preferencias de los cirujanos sobre el momento y la aplicación de intervenciones nerviosas periféricas

Aidan S Weitzner¹, Jeffrey Khong¹, Zachary H Zamore¹

¹From the Departments of Plastic and Reconstructive Surgery.

Annals of plastic surgery

|January 20, 2026

Resumen

La reinervación muscular dirigida (TMR) y la interfaz nerviosa periférica regenerativa (RPNI) se utilizan cada vez más para la profilaxis de neuromas. Sin embargo, persisten las bajas tasas de derivación debido a problemas de coordinación, lo que pone de manifiesto la necesidad de una mayor concienciación interdisciplinaria y vías de derivación optimizadas.

Área de la Ciencia:

Neurocirugía
Cirugía Plástica
Cirugía Ortopédica

Sus antecedentes:

Los neuromas sintomáticos afectan al 5% -25% de los amputados.
La reinervación muscular dirigida (TMR) y la interfaz nerviosa periférica regenerativa (RPNI) son eficaces para el tratamiento y la profilaxis de neuromas.
Falta un consenso nacional sobre la implementación profiláctica de TMR/RPNI.

Objetivo del estudio:

Identificar las características de los cirujanos relacionadas con la intervención de nervios periféricos.
Analizar los patrones de derivación para TMR/RPNI.
Determinar las barreras para una adopción más amplia de TMR/RPNI profiláctico.

Principales métodos:

Se envió una encuesta REDCap a 3628 médicos; respondieron 303.
Los participantes eran miembros de la American Society for Surgery of the Hand (ASSH) o de la Musculoskeletal Tumor Society (MSTS).
Los médicos informaron sobre su formación, uso de procedimientos, momento de aplicación y barreras percibidas.

Principales resultados:

Los cirujanos que realizan cirugía de nervios periféricos tuvieron más probabilidades de tener <10 años de práctica, ser académicos y formarse en cirugía plástica.
El 86% de los cirujanos que realizan cirugía de nervios periféricos utilizan TMR o RPNI para la profilaxis.
El 42% de los cirujanos de nervios citaron la falta de consulta como una barrera
el 38% de los cirujanos que solo realizan amputaciones derivan a TMR/RPNI, con tasas más altas en entornos académicos.

Conclusiones:

La adopción de TMR y RPNI para la profilaxis de neuromas está aumentando.
Las bajas tasas de derivación se atribuyen a desafíos de coordinación y consultas inconsistentes.
Se necesita una mayor concienciación interdisciplinaria y derivaciones optimizadas para traducir la evidencia en la práctica.

Palabras clave:

amputación dolor neuropático nervio periférico

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