[Role and Techniques of Peripheral Nerve Surgery in Orthoplastic Surgery].

Abstract

Orthoplastic surgery integrates principles of trauma surgery and microsurgery to achieve functional restoration in complex limb injuries. While osseous stabilization and soft-tissue coverage have long been established as core components, the importance of early reconstruction of peripheral nerves within the orthoplastic treatment concept is increasingly recognized. The aim of this study is to systematically outline the principles of peripheral nerve surgery in the orthoplastic context.A scoping review was performed with a systematic search of the literature on peripheral nerve surgery in orthoplastic procedures, followed by a narrative synthesis. Original studies, reviews, case series, and clinical guidelines published between 1990 and 2025 were included. The focus was on nerve reconstruction, nerve transfers, neurotized flaps, and strategies for pain prevention in amputations.Peripheral nerve injuries frequently occur as associated injuries in high-energy trauma and have a substantial impact on functional outcomes. Early assessment by peripheral nerve surgeons is essential, as the time window for successful motor reinnervation is limited. In addition to primary repair and autologous nerve grafting, nerve transfers and tendon transfer procedures are increasingly used to achieve functional reconstruction. Neurotized flap procedures, particularly for plantar defect reconstruction, can improve protective sensation and prevent late complications. In major amputations, prophylactic nerve transfers have been shown to reduce the incidence of chronic pain syndromes and to improve prosthetic usability.Peripheral nerve surgery is a key component of orthoplastic care. Its early integration into interdisciplinary treatment algorithms is crucial for long-term functional outcomes. Future studies should aim to standardize indications, techniques, and timing.