Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have emerged as effective interventions for treating and preventing neuromas after amputation. According to a survey of surgeons who perform TMR/RPNI or refer patients for it, referral rates remain low and are limited by coordination challenges and inconsistent consultation pathways. However, the results indicated that there appears to be a growing proportion of surgeons strategically employing the techniques prophylactically for patients following amputation.
A research team conducted the survey to identify the characteristics of surgeons who perform TMR/RPNI or refer patients for it, and barriers to broader adoption of using the technique to prevent neuromas in people with amputations. The REDCap survey was sent to 3,628 physicians, with 303 responses. Participants were members of the American Society for Surgery of the Hand or the Musculoskeletal Tumor Society.
The results indicated that surgeons performing peripheral nerve surgery were more likely to be in practice for ten years or less, work as an academic surgeon, and be trained in plastic surgery.
Among the 142 physicians performing peripheral nerve surgery, 86 percent performed either TMR or RPNI for prophylaxis, and 51 percent stated the effect was comparable for treatment or prophylaxis.
Forty-two percent of nerve surgeons stated that not being consulted by the primary team was a consistent barrier to performing the procedure. Of 89 amputation-only surgeons, 38 percent referred patients for TMR/RPNI, with higher referral rates in the academic setting.
The study, “Surgeon preferences on timing and application of postamputation peripheral nerve interventions: A nationwide survey,” was published in the Annals of Plastic Surgery.
