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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Use of Processed Human Nerve Allograft in Reconstruction of Brachial Plexus Birth Injuries

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  • presenting/speaker Aaron Berger - The Brachial Plexus Program, Nicklaus Children's Hospital, Miami, FL, United States
  • Herbert Valencia - The Brachial Plexus Program, Nicklaus Children's Hospital, Miami, FL, United States
  • John A. I. Grossman - The Brachial Plexus Program, Nicklaus Children's Hospital, Miami, FL, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1782

doi: 10.3205/19ifssh0025, urn:nbn:de:0183-19ifssh00257

Published: February 6, 2020

© 2020 Berger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: To describe our experience with the use of processed human nerve allograft in the reconstruction of brachial plexus birth injuries.

Although the standard approaches to reconstruction of defects in the brachial plexus include sensory nerve autografts and nerve transfers, the availability of processed decellularized nerve allograft presents another option, which may be used in lieu of, or in addition to nerve autografts and nerve transfers.

Methods: The study design consisted of a retrospective review of the medical records of patients who underwent brachial plexus reconstruction that involved the use of processed human nerve allograft at our hospital from April 2012 to October 2013. Thirteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (JAIG).

Results: The participants ranged in age from 6 to 12 months. Of the 13 patients, 7 were female (54%) and 6 were male (46%). 7 were affected on the left (54%) and 6 were affected on the right (46%). 9 patients sustained upper plexus (Erb's) injuries (69%); 2 patients sustained extended Erb's injuries (15%) and 2 patients sustained global injuries (15%). 7 patients underwent concomitant spinal accessory to suprascapular nerve transfer (54%). Concomitant autograft was used in 5 cases: sural nerve autograft was used for reconstruction in 4 cases (31%) and cervical plexus autograft was used in 1 case (8%).

The number of processed nerve allografts used in each case ranged from 1-2; two patients each received 2 grafts. The length of processed nerve allograft ranged from 3.0-4.7cm with average length of 4.2cm. The allograft was placed in an end-to-end fashion in 4 cases (31%) and end-to-side fashion in 9 cases (69%). The donor signal was obtained from the C5 and/or C6 nerve roots and the recipient sites included the suprascapular nerve, anterior and posterior divisions of the upper trunk and the middle trunk.

Conclusions: Although the observed recovery in many of the patients cannot be exclusively attributed to the use of processed nerve allograft, the results of the present study suggest that processed nerve allografts may be used in a supplemental fashion in reconstruction of brachial plexus birth injuries.