Regenerative Peripheral Nerve Interface Reconstruction for Recurrent Terminal Neuromas After War-Related Amputation in Ukrainian Service Members

Background Long-term recurrence after non-reconstructive surgery for painful postamputation neuromas is difficult to estimate in wartime cohorts because relocation and disrupted follow-up limit outcome assessment. Methods We reviewed 121 Ukrainian service members who underwent non-reconstructive surgery for 280 symptomatic terminal neuromas between 2022 and 2024. Follow-up was attempted in 2026. Neuropathic residual-limb pain requiring further surgery was classified as same-nerve recurrence or newly manifest pain from a nerve that had been asymptomatic at the index procedure. Patients with same-nerve recurrence who underwent secondary regenerative peripheral nerve interface (RPNI) reconstruction formed a nested subgroup. The RPNI endpoint was change in Defense and Veterans Pain Rating Scale (DVPRS) score at 6 months. Results Follow-up was available for 44 of 121 patients (36.4%); 77 could not be contacted. Twelve required further surgery for recurrent or newly emergent neuropathic pain (27.3%; 95% confidence interval, 15.0%–42.8%). Eight had painful recurrence in previously treated nerves (18.2%), whereas four developed pains from previously asymptomatic nerves (9.1%). The eight-patient RPNI subgroup had 25 recurrent symptomatic neuromas; seven additional asymptomatic neuromas were treated during revision. Mean DVPRS score decreased from 7.6 ± 1.8 to 3.5 ± 1.1 at 6 months (mean reduction, 4.1 points; P = 0.008). No further RPNI revision was documented in 2026 records. Conclusions Secondary RPNI may provide pain relief after failed non-reconstructive neuroma surgery. The small subgroup and loss to follow-up limit conclusions about long-term durability and full-cohort treatment failure. Prospective multicenter follow-up incorporating records from other institutions is needed in wartime populations.