Targeted Muscle Reinnervation Versus Regenerative Peripheral Nerve Interface

Introduction: Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) have demonstrated promising results in reducing neuroma pain post-amputation. Although the benefits of these techniques have been widely reported, there is limited evidence comparing the postoperative complication profiles of TMR and RPNI. This systematic review evaluates postoperative surgical complications and operative time associated with TMR and RPNI after amputation. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024521608). Seven databases were searched through May 2026 for studies evaluating postoperative surgical complications after upper or lower extremity amputation with TMR or RPNI. Study characteristics, complication outcomes, and operative time data were extracted and synthesized descriptively. Results: Eighteen studies met inclusion criteria, including 8 comparative cohort studies and ten noncomparative studies. Reported complication rates varied substantially across studies. Comparative RPNI studies generally demonstrated lower rates of delayed wound healing, SSI, and revision surgery compared with standard amputation controls. Comparative TMR studies demonstrated mixed findings, with some cohorts reporting higher rates of delayed wound healing and SSI, whereas revision surgery rates were often lower than standard amputation controls. Operative time increased for both TMR and RPNI, ranging from ~20 minutes to more than 2 hours depending on operative approach and institutional experience. Conclusions: Current evidence suggests that both TMR and RPNI demonstrate broadly comparable postoperative risk profiles relative to standard amputation, although RPNI may be associated with fewer early postoperative complications in limited comparative studies. Further prospective comparative studies with standardized outcome reporting are needed to better define the relative risks and benefits of each technique.