gms | German Medical Science

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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Evaluation of Nerve Reconstruction in the Hand by Gap Length with Processed Nerve Allograft

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  • presenting/speaker Bauback Safa - The Buncke Clinic, San Francisco, United States
  • Timothy Niacaris - JPS Health Network, Fort Worth, United States
  • Sonu Jain - Ohio State University, Columbus, United States
  • Mehir Desai - Vanderbilt Health, Nashville, United States
  • Fraser Leversedge - Duke Health, Durham, United States
  • Gregory Buncke - The Buncke Clinic, San Francisco, 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. DocIFSSH19-1066

doi: 10.3205/19ifssh1339, urn:nbn:de:0183-19ifssh13397

Published: February 6, 2020

© 2020 Safa 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: Nerve gap injuries associated with hand trauma are very common. Current reconstruction methods for addressing nerve gaps include nerve autograft, processed nerve allograft, and synthetic conduits. Data were queried from the on-going international registry for nerve reconstructions with processed nerve allograft to determine effect of gap to outcomes. We report on the return of meaningful sensation by gap length after nerve repairs in the hand.

Methods: This multicenter IRB/Ethics approved international registry is designed to collect data associated with processed nerve allografts (Avance® Nerve Graft, AxoGen). The registry database was queried for nerve repairs in the hand with a minimum of six months of quantitative follow-up. Demographics, nerve injury/repair, assessments, and safety were evaluated. Data included static/moving 2-point discrimination, Semmes-Weinstein Monofilaments, and tens score. The cohort was stratified into three gap groups: Small (< 15mm), Mid (15-29mm), and Long (≥30mm). Meaningful recovery was defined as S3 or greater on the MRC scale. Higher thresholds of recovery were evaluated in repairs with at least 1-year follow-up.

Results and Conclusions: The cohort consisted of 325 nerve injuries. The mean patient age was 42±16years; patients were predominantly male. The mean time-to-repair was 1 (0-2579) days. Mean gap length was 20±13mm. The mean follow-up time was 11.6 months. Overall meaningful recovery was reported in 87% of repairs with 70% reaching higher thresholds. Return of sensation was consistent across gap subgroups: Small (91%), n=104; Mid (87%),n=137; and Long (83%); n=83. Outcomes by mechanism of injury were significantly different (p=0.03) with lacerations and complex injuries (gunshots/blast, amputations, avulsions) reporting 91%, n=206 and 80%, n=95 recovery respectively. No related adverse events were reported.

Processed nerve allograft can be used successfully with consistent outcomes in both short and long gap reconstructions. Overall meaningful recovery was reported in 87% of repairs. Limitations of this study include the observational study design and lack of active control. These outcomes compare favorably to historical data in the literature for nerve autograft and exceed those for conduit.