OasisLMS

This study examines factors associated with neuropathic pain following major lower extremity amputation in 1,565 patients undergoing above-the-knee amputation, knee disarticulation, or below-the-knee amputation. Neuropathic pain developed in 37% of patients, with phantom limb pain accounting for most cases. Proximal amputation level, younger age, and a history of psychiatric disease were associated with greater risk, whereas diabetes, hypothyroidism, and elevated creatinine were associated with lower odds of neuropathic pain. The authors suggest that differences in nerve regenerative potential may contribute to these associations and propose using these factors to identify higher-risk patients who may benefit from primary targeted muscle reinnervation or regenerative peripheral nerve interfaces. These findings may help surgeons individualize nerve-end management and allocate specialized resources more effectively at the time of amputation.

Intended Audience

This educational activity is intended for plastic surgery practitioners, residents, and other healthcare professionals interested in translating expanded knowledge into practice for the improvement of patient outcomes in plastic and reconstructive surgery.

Learning Objectives

After viewing this course, the participant should be able to:

1. Describe the incidence and clinical presentation of neuropathic pain following major lower extremity amputation.
2. Identify patient and procedural factors independently associated with increased or decreased odds of postamputation neuropathic pain.
3. Explain how age, amputation level, and selected comorbidities may influence neuropathic pain through their effects on nerve regeneration.
4. Evaluate the role of targeted muscle reinnervation and regenerative peripheral nerve interfaces in patients at increased risk for neuropathic pain.
5. Apply study findings to risk stratification and resource allocation for nerve-end management during lower extremity amputation.

Jonathan Lans, M.D., Ph.D. Olivier Q. Groot, M.D. Merel H. J. Hazewinkel, B.A. Philip B. Kaiser, M.D. Santiago A. Lozano-Calderón, M.D., Ph.D. Marilyn Heng, M.D. Ian L. Valerio, M.D. Kyle R. Eberlin, M.D.

Editor-in-Chief: Kevin C. Chung, MD

Co-editor: Amy S. Colwell, MD

Kelly Ledbetter, MD

Neil McMullin, MD

• Systems-based Practice
• Medical Knowledge
• Practice-based Learning and Improvement

Accreditation

The American Society of Plastic Surgeons (ASPS) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation

The ASPS designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AMA PRA Category 1 Credit™: 1.0

Media: Journal Article

Release Date: 9/16/2026

Expiration Date: 9/16/2029*

Estimated time to complete this course: 1 hour

*Course access ends on course expiration date

Disclosure Policy

The American Society of Plastic Surgeons (ASPS) requires all instructors, planners, reviewers, managers and other individuals in a position to control or influence the content of an activity to disclose all relevant financial relationships or affiliations. All identified conflicts of interest must be resolved and the educational content thoroughly vetted by ASPS for fair balance, scientific objectivity and appropriateness of patient care recommendations. ASPS also requires faculty/authors to disclose when off-label/unapproved uses of product are discussed in a CME activity or included in related materials.

Disclaimer: All relevant financial relationships for planners, faculty and others in control of content (either individually or as a group) are reviewed by the ASPS Continuing Education Committee and have been mitigated, if applicable.

The following planners/faculty members/reviewers have the following disclosures:

Ian L. Valerio, M.D. - consultant for AxoGen, Integra Lifesciences, and Stryker Corp.
Kyle R. Eberlin, M.D. - consultant for AxoGen, Integra Lifesciences, and Checkpoint.

 No funding was received for this article.

Jonathan Lans, MD, PhD
Olivier Q. Groot, MD

Merel H. J. Hazewinkel, BA

Philip B. Kaiser, MD

Santiago A. Lozano-Calderon, MD, PhD
Marilyn Heng, MD
Kelly Ledbetter, MD
Neil McMullin, MD

Recognition Statement

The Continuing Medical Education (CME) credits offered by this activity are enhanced by ASPS Learner Credit Reporting for learners who have opted into this reporting. Successful completion of this CME activity enables active American Board of Surgery (ABS) members the opportunity to earn credit toward the CME requirement of the ABS's Continuous Certification program when claimed within 30 days of completion of the activity.

Directly provided by the American Society of Plastic Surgeons® (ASPS®)

Participants in ASPS-accredited education who want their CME credits reported to certifying and state licensing boards must opt-in to reporting and add their NPI as well as state license ID and/or collaborating board ID(s) before claiming credit.