1. A Preliminary Assessment of the Utility of Large-Caliber Processed Nerve Allografts for the Repair of Upper Extremity Nerve Injuries.
- Author
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Isaacs J and Safa B
- Subjects
- Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nerve Regeneration physiology, Neurosurgical Procedures methods, Peripheral Nerve Injuries physiopathology, Peripheral Nerves physiology, Recovery of Function physiology, Registries, Sensation physiology, Young Adult, Peripheral Nerve Injuries surgery, Peripheral Nerves transplantation, Upper Extremity innervation
- 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., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Both Jonathan Isaacs and Bauback Safa have received speaking fees and partial research support from AxoGen, Inc. Jonathan Isaacs has received educational support from AxoGen, Inc. Jonathan Isaacs is a co-principal investigator in an AxoGen, Inc–sponsored study (grant through Jonathan Isaacs’s institution).
- Published
- 2017
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