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J Reconstr Microsurg
DOI: 10.1055/a-2817-5038
Original Article

Access to Reconstructive Plastic Surgery and Nerve Procedures in Lower Extremity Amputations

Authors

  • Jennifer Krupa Shah 

    1   Dartmouth College Geisel School of Medicine, Hanover, United States (Ringgold ID: RIN12285)
    2   Stanford University Division of Plastic & Reconstructive Surgery, Stanford, United States (Ringgold ID: RIN200431)

  • Daniel Najafali 

    3   Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, United States (Ringgold ID: RIN2468)

  • Devi Lakhlani

    4   Stanford University School of Medicine, Stanford, United States (Ringgold ID: RIN10624)

  • Uchechukwu Amakiri

    5   Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, United States (Ringgold ID: RIN12266)

  • Rahim S. Nazerali

    6   Department of Surgery, Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, United States (Ringgold ID: RIN10624)

  • Clifford C Sheckter

    7   Surgery, Stanford University Division of Plastic & Reconstructive Surgery, Stanford, United States (Ringgold ID: RIN200431)
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Background: Neuroma complicates lower extremity (LE) amputations causing significant morbidity. This study examines the relationship between access to plastic surgery and the likelihood of receiving a neuroma-preventing nerve procedure with LE amputation in the US. Methods: Using the National Inpatient Sample (NIS), 2016–2021, ICD-10 codes identified encounters undergoing above- or below-knee LE amputation with or without concurrent nerve procedures (targeted muscle reinnervation and regenerative peripheral nerve interface). Plastic surgery volume was determined using ICD-10-PCS codes. Outcomes included population-adjusted LE amputation incidence, odds of concurrent nerve procedures, and their incidence relative to facility plastic surgery volume. Statistical analysis included univariate analysis and multivariate Poisson and logistic regression models. Results: 245,170 weighted encounters underwent LE amputation, of which only 1,525 (0.6%) included concurrent nerve procedures. Population-adjusted LE amputation incidence remained stable throughout the study period (p=0.159). Higher LE amputation incidence was associated with higher comorbidity burden and Black and Native American race (p≤0.036). Odds of nerve procedures increased with more recent surgery year, younger age, higher income, and Black race (p≤0.044). Nerve procedure incidence at facilities in the highest quartile of plastic surgery volume was significantly higher than that of facilities in the lowest quartile (IRR 21.949; 95% CI: 16.493–29.211; p<0.001). Conclusion: Amidst stable population LE amputation incidence, Black and Native American race increased LE amputation incidence. Higher income and Black race elevated odds of concurrent nerve procedures. Increasing facility plastic surgery volume was associated with increased concurrent nerve procedure incidence in LE amputation.



Publication History

Received: 17 October 2025

Accepted after revision: 16 February 2026

Accepted Manuscript online:
23 February 2026

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