title: A Preliminary Assessment of the Utility of Large-Caliber Processed Nerve Allografts for the Repair of Upper Extremity Nerve Injuries.
abstract: Background:Cabled sensory nerve autografts are the historical gold standard for overcoming gaps in larger diameter nerves as repair utilizing large-diameter autograft risks central graft necrosis. Commercially available processed nerve allograft (PNA) is available in diameters up to 5 mm but represents an acellular 3-dimensional matrix as opposed to viable tissue. The purpose of this study is to specifically evaluate whether similar concerns regarding the use of large-caliber PNA are warranted.Methods:The RANGER Registry is an active database designed to collect injury, repair, safety, and outcomes data for PNAs (Avance® Nerve Graft; AxoGen, Inc, Alachua, Florida) according to an institutional review board-approved protocol. The database was queried for patients presenting with large-caliber nerve allograft repairs in the upper extremity. Identified patients reporting quantitative outcomes with a minimum of 9-month follow-up were included in the data set.Results:The large-caliber PNA subgroup included 13 patients with 15 injuries. The mean ± SD age was 36 ± 22 years. Large-caliber single-stranded repairs included twelve 4- to 5-mm-diameter grafts. Large-caliber cabled repairs included the combined use of 3- to 4-mm and 4- to 5-mm-diameter nerve allografts in 3 repairs. The mean nerve gap was 33 ± 10 mm with a mean follow-up time of 13 months. Available quantitative data reported meaningful recovery of sensory and motor function in 67% and 85% of the repairs, respectively.Conclusion:Although based on a small subset of patients, PNAs of up to 5 mm in diameter appear capable of supporting successful nerve regeneration.
authors.affiliation: Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Isaacs
authors.affiliation: The Buncke Clinic, San Francisco, CA, USA.
authors.forename: Bauback
authors.initials: B
authors.lastname: Safa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology; D019635:Neurosurgical Procedures / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000503:physiopathology / Q000601:surgery*; D010525:Peripheral Nerves / Q000502:physiology / Q000637:transplantation*; D020127:Recovery of Function / Q000502:physiology; D012042:Registries; D012677:Sensation / Q000502:physiology; D034941:Upper Extremity / Q000294:innervation*; D055815:Young Adult
keywords: acellular nerve allograft; large-diameter nerve graft; nerve gap; nerve repair; nerve repair outcomes