Back to 2026 Abstracts
Utilization, Safety, and Timing of Reconstructive Surgery for Acquired Limb Paralysis: A National and Single-Center Analysis
Bashar M. Alsamman, B.A.1,2; John J. Lee, B.A.1,3; Dany Y. Matar, B.A.1,4; Arman Zadeh, B.S.1; Fares Lebbos, M.D.1; Dennis P. Orgill, M.D., Ph.D.4; Sami H. Tuffaha, M.D.1 1Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA 2University of Rochester School of Medicine, Rochester, NY, USA 3University of Virginia School of Medicine, Charlottesville, VA, USA 4Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA
Background: Paralytic limb dysfunction may be treated with nerve transfer, tendon transfer, or joint stabilization. Despite growing use of nerve transfer, national patterns, safety, indications, donor selection, and timing remain unclear. We analyzed national and single-center cohorts to characterize reconstructive practice. Methods: Adults with acquired paralytic diagnoses undergoing reconstruction were identified in ACS-NSQIP (20082024). Annual utilization was modeled with Poisson regression adjusted for total case volume; 30-day morbidity with Firth-penalized regression. A single-surgeon practice (20202026) was analyzed descriptively for detail NSQIP omits. Results: Nationally (n=129), volume was stable (IRR 1.03, 95% CI 0.991.07). Peripheral nerve reconstruction grew fastest (n=44; IRR 1.16, 1.071.26); tendon-based procedures remained largest (74%) but did not increase (IRR 0.99, 0.951.04). Morbidity was 5.4%, with no reoperations or deaths and no procedure category predicting complications. The single-center series (33 patients, 52 operations) included 30 nerve transfers (58%), 17 tendon transfers (33%), five fusions (10%), three gracilis transfers (6%). Patients were predominantly C4C6 SCI (52%), ASIA A (42%). Nerve transfers targeted hand reanimation (grasp/pinch 46%, opening 31%), most using supinator (n=21), brachialis (n=12), and axillary (n=8) donors. Median 2 transfers/operation (IQR 13); nine (27%) had staged nerve-plus-tendon reconstruction, twelve (36%) bilateral. Surgery occurred a median 22.6 months post-injury (IQR 10.666.2). Conclusions: Peripheral nerve reconstruction increasingly leads reconstruction for acquired paralysis, with low morbidity, often staged and multimodal for hand reanimation. Delayed surgery highlights the need for earlier referral and multicenter study.
Back to 2026 Abstracts
