Prophylactic Regenerative Peripheral Nerve Interfaces to Prevent Postamputation Pain

Plast Reconstr Surg. 2019 Sep;144(3):421e-430e. doi: 10.1097/PRS.0000000000005922.


Background: Postamputation pain affects a large number of individuals living with major limb loss. Regenerative peripheral nerve interfaces are constructs composed of a transected peripheral nerve implanted into an autologous free muscle graft. The authors have previously shown that regenerative peripheral nerve interfaces can be used to treat symptomatic end neuromas that develop after major limb amputation. In this study, they investigated the potential of prophylactic interfaces to prevent the formation of symptomatic neuromas and mitigate phantom limb pain.

Methods: Patients who underwent limb amputation with and without prophylactic regenerative peripheral nerve interface implantation were identified. A retrospective review was performed to ascertain patient demographics, level of amputation, and postoperative complications. Documentation of symptomatic neuromas and phantom limb pain was noted.

Results: Postoperative outcomes were evaluated in a total of 90 patients. Forty-five patients underwent interface implantation at the time of primary amputation, and 45 control patients underwent amputation without interfaces. Six control patients (13.3 percent) developed symptomatic neuromas in the postoperative period compared with zero (0.0 percent) in the prophylactic interface group (p = 0.026). Twenty-three interface patients (51.1 percent) reported phantom limb pain, compared with 41 control patients (91.1 percent; p < 0.0001).

Conclusions: Prophylactic regenerative peripheral nerve interfaces in major limb amputees resulted in a lower incidence of both symptomatic neuromas and phantom limb pain compared with control patients undergoing amputation without regenerative peripheral nerve interfaces, suggesting that prevention of peripheral neuromas following amputation may diminish the central pain mechanisms that lead to phantom limb pain.

Clinical question/level of evidence: Therapeutic, III.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amputation / adverse effects*
  • Amputation / methods
  • Amputation Stumps / innervation
  • Case-Control Studies
  • Child
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Nerve Regeneration*
  • Neuroma / epidemiology*
  • Neuroma / etiology
  • Peripheral Nerves / physiology
  • Peripheral Nerves / transplantation*
  • Phantom Limb / epidemiology
  • Phantom Limb / etiology
  • Phantom Limb / prevention & control*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult