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Perspectives in Bionic Reconstruction and Post-Amputation Management

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Prof. Dr. Alexander Gardetto

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Guest Editor

1. Division of Plastic, Aesthetic and Reconstructive Surgery with Hand Surgery, Brixsana Private Clinic, Julius Durst 28, 39042 Bressanone, Italy
2. Clinic of Plastic, Reconstructive and Aesthetic Surgery, Padova University Hospital, Via Nicolo Giustiniani 2, 35128 Padova, Italy
Interests: bionic reconstruction; advanced nerve interface surgery (TSR/TMR/RPNI/AMI); upper-limb neuroprosthetics; complex peripheral nerve injuries; sensory restoration; phantom-limb pain; reconstructive microsurgery
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Dr. Jennifer Ernst

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Guest Editor Assistant

Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Interests: bionic reconstruction; advanced nerve interface surgery (TSR/TMR/RPNI/AMI); upper-limb neuroprosthetics; complex peripheral nerve injuries; sensory restoration; phantom-limb pain; reconstructive microsurgery

Special Issue Information

Dear Colleagues,

Advances in surgical techniques, postoperative recovery, and rehabilitation after amputation are now central to modern bionic reconstruction. Progress in Targeted Sensory Reinnervation, Targeted Muscle Reinnervation, Agonist–Antagonist Myoneural Interface, Osseointegration, and regenerative strategies such as Regenerative Peripheral Nerve Interfaces, together with next-generation prosthetic systems, is redefining functional restoration. Contemporary prostheses integrate high-resolution sensors, AI-assisted control, and optimized biomechanical design, enabling more natural motor execution and enhanced sensory feedback. Complementary neurorehabilitation protocols and embodiment-focused training further strengthen long-term outcomes.

In this Special Issue, we invite authors to contribute high-quality manuscripts that illuminate current advances and future directions in prosthetic innovation and amputation management.

Prof. Dr. Alexander Gardetto
Guest Editor

Dr. Jennifer Ernst
Guest Editor Assistant

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12 pages, 225 KB

Open AccessArticle

Comparison of Reoperation and Complication Rates Between Acute and Delayed Advanced Nerve Interface Procedures in Lower-Extremity Amputees

by Kevin Kuan-I Lee, Omer Sadeh, Alberto Barrientos, Anne Genzelev, Omri Ayalon, Nikhil A. Agrawal, Jonathan M. Bekisz and Jacques H. Hacquebord

J. Clin. Med. 2026, 15(2), 882; https://doi.org/10.3390/jcm15020882 - 21 Jan 2026

Viewed by 421

Abstract

Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees. Methods: A retrospective cohort study was conducted including 74 patients who underwent acute or delayed targeted muscle reinnervation and/or regenerative peripheral nerve interface procedures between 2019 and 2025 at a tertiary academic medical center. Procedures performed concurrently with amputation or during early-stage reconstruction were classified as acute, whereas procedures performed more than one month after amputation were classified as delayed interventions. The primary outcome was postoperative surgical complications occurring within one year. Mann–Whitney U and chi-square tests were used for group comparisons. Univariable and multivariable logistic regression analyses were performed to identify factors associated with surgical complications, adjusting for potential confounders. A p-value < 0.05 was considered statistically significant. Results: Of 80 limbs, 47 (58.8%) underwent acute and 33 (41.3%) underwent delayed procedures. One-year complication rates were 23.4% in the acute group, and 12.1% in the delayed group, with wound-related complications predominantly occurring in patients undergoing amputation for infection or vascular disease. Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions. On univariable and multivariable analyses, early procedures demonstrated higher odds of surgical complications. However, these associations did not reach statistical significance and were limited by baseline differences in patient comorbidity and etiology. Conclusions: Early advanced nerve interface procedures were performed in more medically complex patients and were associated with higher observed rates of surgical complications, whereas delayed procedures were associated with a higher incidence of recurrent symptomatic neuromas. These findings underscore the importance of patient selection, etiology of amputation, and surgical context, rather than timing alone, when determining the optimal approach to nerve interface reconstruction following lower-extremity amputation. Full article

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