What is the current Dutch nerve management during amputation surgery?

Abstract

Peripheral nerve management during limb amputation is essential, as neuromas frequently form after nerve transection. Some of which are painful and impair patient quality of life. Selecting the appropriate technique for nerve management is important as it may impact the development of painful neuromas. Diagnosis is often complex, and treatments may yield limited success, highlighting the importance of careful nerve handling at the time of surgery. In this study, we questioned Dutch plastic surgeons about their knowledge and preferred technique(s) in managing nerves during amputation surgery. An email survey was distributed among Dutch (plastic) surgeons. The survey was designed in LimeSurvey. The questionnaire addressed background knowledge, preferred nerve management approaches during amputations, and subsequent neuroma treatments. Data were collected anonymously and analyzed using descriptive statistics. Of 390 surgeons, 72 responded (18.5% response rate; 91.7% plastic surgeons). Most respondents (57%) specialized in hand and wrist surgery, with 69% performing 1-10 amputations annually. Surgeons favoring traction neurectomy had less experience (p=0.027). Muscle burying (n=64) was the most familiar technique, followed by bone burying, end-to-side suturing, and targeted muscle reinnervation. Most respondents addressed nerve pain (93%) or considered revision surgery (95%) postoperatively. This study provides an overview of nerve management and neuroma treatment preferences among Dutch (plastic) surgeons. Awareness of various techniques appears widespread, underscoring the importance of training exposure to enhance procedural competence.