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Comparisons of Patient Smoking Status and Functional Recovery Following Peripheral Nerve Repair with Processed Nerve Allograft
Bauback Safa, MD1; Brian Rinker, MD2; Renata V. Weber, MD3, Jozef Zoldos, MD4; John Ingari, MD5; Jeffrey A. Greenberg, MD6; Wesley Thayer, MD, PhD7; Jason Ko, MD8; Gregory M. Buncke, MD1
1The Buncke Clinic, San Francisco, CA; 2Division of Plastic Surgery, University of Kentucky, Lexington, KY; 3Institute for Nerve, Hand, and Reconstructive Surgery, Rutherford, NJ; 4Arizona Center for Hand Surgery, Phoenix, AZ; 5WellSpan Health Orthopedics, York, PA; 6The Indiana Hand to Shoulder Center, Indianapolis, IN; 7Department of Plastic Surgery, Vanderbilt University, Nashville, TN; 8Division of Plastic and Reconstructive Surgery, University of Washington, Harborview Medical Center, Seattle, WA

Introduction: Exposure to cigarette smoke has been associated to negatively impact recovery, as it constricts blood vessels supplying nutrients to damaged peripheral nerves inhibiting the regeneration process. In 2008, a national registry (RANGER®) was initiated to collect data on the use of processed nerve allograft (PNA), Avance® Nerve Graft, AxoGen, Inc. The resultant database allows for the analysis of patient populations, nerve injury epidemiology, and outcomes of processed nerve allografts. Here we report our findings from a subgroup analysis of patient smoking status and functional recovery following peripheral nerve repair with processed nerve allograft.

Materials & Methods: The registry database was queried for repairs with quantitative outcomes data from subjects reporting smoking status and medical history. This dataset was grouped into “Smokers” defined as subjects reporting a history of smoking and “Non-smokers” defined as healthy subjects reporting no history of smoking. Demographics and outcomes analysis were performed. Meaningful recovery was defined by the MRCC scale at S3/M3 or greater for sensory and motor function. Comparisons were made between the groups and historical data published in the literature.

Results: There were 70 subjects with 92 repairs reporting sufficient history and quantitative follow-up data. There were 25 subjects with 32 repairs in the “Smoking” group and 45 subjects with 60 repairs in the “Non-smoking group”. Demographics were comparable between the two groups. Meaningful recovery for the total population was 86% with 81% and 90% reported in the “Smokers” and “Non-Smokers” groups respectively. See Table 1 for demographics and outcomes. A statistically significant difference was found between the groups for moving two-point discrimination (2PD), with greater recovery in the Non-Smoking group, (p<0.05). There were no reported adverse events.

Conclusion: Processed nerve allograft demonstrated meaningful recovery across both populations. While levels of meaningful recovery were comparable between the groups, a statistical difference was reported in moving 2PD, with greater recovery in the Non-Smoking group. These outcomes compare favorably to historical data in the literature for nerve autograft and exceed that of nerve tube conduit. Outcomes from this analysis provide further evidence that suggest smoking may contribute to decreased functional recovery. Data from this study should be considered when designing future studies. The RANGER® registry remains ongoing and additional clinical data collection will allow for further comparisons of these populations.



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