Article
Outcomes after Long Nerve Gap Reconstructions in the Upper Extremity with Processed Nerve Allograft
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Authors
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Bauback Safa
- The Buncke Clinic, San Francisco, United States
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Timothy Niacaris
- JPS Health Network, Fort Worth, United States
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Leon Nesti
- Walter Reed National Military Medical Center, Bethesda, United States
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Jozef Zoldos
- Arizona Center for Hand Surgery, Phoenix, United States
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Jaimie Shores
- Johns Hopkins Bayview Medical Center, Baltimore, United States
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Gregory Buncke
- The Buncke Clinic, San Francisco, United States
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Long segmental nerve defects after traumatic injuries pose a significant surgical challenge. Current treatment modalities include nerve autograft, nerve transfers, and most recently processed nerve allograft. Recovery outcomes in these repairs however are often limited due to the challenges of this study population. Data was queried from an on-going nerve repair registry for subjects reporting long term follow-up after reconstruction in the upper extremity with processed nerve allograft. Here we report on the recovery outcomes of long gap nerve injuries reconstructed with processed nerve allografts in the upper extremity.
Methods: The RANGER® Study is a multi-center IRB/Ethics approved registry designed to collect data on the use and outcomes of processed nerve allografts (Avance® Nerve Graft, AxoGen). The registry database was queried for upper extremity nerve repairs 30 mm or greater with a minimum of 12 months of follow-up data. The cohort was further stratified into sensory and mixed/motor nerve subgroups. Outcomes data were incorporated into the MRC scale for sensory and motor function. Meaningful recovery was defined as = S3/M3 on the MRC scale with higher thresholds defined at S3+/M4 or greater.
Results and Conclusions: The long gap cohort consisted of 91 injuries (58 sensory and 33 mixed/motor nerves). The mean age was 41±18 (18-76) years. The median time to repair was 6 days after injury. Mean gap length was 39±11 (30-70) mm. The mean follow up time was 21 months. Overall meaningful recovery was reported in 81% of repairs with 43% reaching higher thresholds. Meaningful recovery was reported in 81% of sensory nerve repairs. Return of sensory or motor function was reported in 73% and 63% respectively in the mixed/motor subgroup. These outcomes were comparable to historical literature of long gap reconstructions with nerve autograft. No related adverse events were reported.
Processed nerve allograft can successfully be used in long gap nerve reconstructions. Meaningful recovery was reported in 81% of repairs with outcomes as expected across subgroups. No adverse events were reported. These outcomes compare favorably to historical data in the literature for nerve autograft. Limitations of this study include the challenges of obtaining long term follow-up, observational study design, and lack of an active control. The registry continues to collect outcomes data on the use of processed nerve allografts.
