Background: Chronic postamputation pain—phantom limb pain (PLP) and residual limb pain—is a major barrier to rehabilitation, with symptomatic neuroma formation a key peripheral contributor. The regenerative peripheral nerve interface (RPNI) provides a physiologic target for transected nerves. This review evaluated the effect of prophylactic RPNI, performed at the time of amputation, on pain-related outcomes. Methods: PubMed, Cochrane CENTRAL, ScienceDirect, SpringerLink, and MinhaBVS were searched through 23 November 2025 for comparative studies of prophylactic RPNI versus standard nerve management in major limb amputation. Primary outcomes were symptomatic neuroma incidence and PLP; chronic opioid use was a secondary outcome. Dichotomous outcomes were pooled using random-effects risk ratios (RR); for outcomes with zero events in one arm, the fixed-effect Peto odds ratio (OR) was used as the primary estimate. Risk of bias was assessed with ROBINS-I and certainty with GRADE. Results: Five comparative cohort studies (238 patients) were included; the primary pooled outcomes were derived from three of these cohorts (symptomatic neuroma, 196 patients; phantom limb pain, 181 patients), with two further studies contributing supportive descriptive data. Prophylactic RPNI markedly reduced symptomatic neuroma formation (0/97 vs. 20/99; Peto OR 0.11, 95% CI 0.05–0.29; p < 0.001; I² = 0%) and PLP (RR 0.52, 95% CI 0.40–0.69; p < 0.001; I² = 0%). Chronic opioid use at 12 months was also reduced (Peto OR 0.12, 95% CI 0.05–0.29; p < 0.001). Findings were consistent across pediatric, dysvascular, and oncologic populations. Certainty was low to very low. Conclusions: Prophylactic RPNI is associated with substantial, consistent reductions in symptomatic neuroma, phantom limb pain, and chronic opioid use after limb amputation. Despite reliance on low-certainty observational data, these consistent findings suggest that prophylactic RPNI may be a useful component of active nerve management; confirmation in prospective, adequately powered comparative studies is required.

Purpose of a study: to summarize current strategies for the regeneration of peripheral nerves and the spinal cord and to analyze the role of biomimetic materials and nanostructured nerve conduits in reconstructive neurosurgery. Material and methods . A narrative review of publications indexed in PubMed, Scopus, and Web of Science (2020–2025) was conducted using the search terms “peripheral nerves”, “spinal cord”, “neuroregeneration”, “biomaterials”, “nerve conduits”, and “nanomaterials”. Experimental and clinical studies, narrative reviews, and metaanalyses related to tissue engineering and surgical approaches for neural repair were included. Structural properties of materials, mechanisms of axonal growth, and indicators of functional recovery were analyzed. Results . Biomimetic materials replicating extracellular matrix architecture and providing directional guidance for axonal growth demonstrate the highest therapeutic potential. Nanostructured and functionalized nerve conduits incorporating growth factors, cellular components, and conductive elements enhance peripheral nerve regeneration and partially restore electrophysiological conduction across spinal cord lesions. Conclusion . Bioengineering technologies based on nanostructured and biomimetic conduits broaden the possibilities of reconstructive neurosurgery. Future efforts should focus on optimizing combinations of materials and bioactive agents to improve translation of experimental results into clinical practice.

Background: Fascicular turnover flap (FTF) is a donor-sparing option for segmental facial nerve repair. This study compared autologous nerve grafting with proximally based and distally based FTF in a rat facial nerve model. Methods: Adult male Wistar rats were randomized to autograft, proximal FTF, or distal FTF (n = 8 per group). A single additional animal with an untreated defect served as a qualitative histological reference. The prespecified primary endpoint was whisker motion amplitude at week 8; the secondary endpoints were central section histomorphometry (nerve tissue area, µm²) and variability metrics (IQR, SD, and coefficient of variation) as measures of reproducibility. Non-parametric tests (Kruskal–Wallis; Mann–Whitney U) were used; pairwise functional comparisons were Holm-corrected; and effect sizes were expressed as Cliff’s δ. Results: At week 8, the overall functional comparison was significant (Kruskal–Wallis p = 0.047), but no pairwise contrast remained significant after Holm correction. Functional recovery was highest in the autograft group, followed by proximal FTF and distal FTF. Both FTF groups showed lower inter-animal variability than autograft for the week-8 functional endpoint, with the distal FTF showing the lowest dispersion. Central section nerve area comparisons did not reach global significance; effect sizes and descriptive statistics favored autograft, and a single unadjusted pairwise contrast (autograft > proximal FTF) should be interpreted cautiously. Conclusions: Both FTF configurations achieved measurable functional and structural regeneration while avoiding an additional free donor nerve graft. Within an 8-week window, autograft remained the benchmark. Between FTF variants, distal FTF produced more stable functional outcomes, but this did not translate into superior functional recovery. Confirmation in larger, balanced cohorts with longer follow-up and vascular/neural labeling is warranted.