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Outcomes from a Registry Study of Complex Peripheral Nerve Injuries Reconstructed using Processed Nerves Allografts
Bauback Safa, MD1; Jozef Zoldos, MD2; Renata V. Weber, MD3; Dmitry Tuder, MD4; Mickey Cho, MD4; Jason Ko, MD5; Brian Rinker, MD6; Wesley Thayer, MD, PhD7; Gregory Buncke, MD1
1The Buncke Clinic, San Francisco, CA; 2Arizona Center for Hand Surgery, Phoenix, AZ; 3Institute for Nerve, Hand, and Reconstructive Surgery, Rutherford, NJ; 4San Antonio Military Medical Center, San Antonia, TX; 5University of Washington, Harborview Medical Center, Seattle, WA; 6University of Kentucky, Lexington, KY; 7Vanderbilt University, Nashville, TN

Introduction: Severe trauma to the upper extremities often results in complex traumatic injuries requiring extensive tissue reconstruction presenting a challenge to even the most skilled surgeon. A recent nerve repair option, processed nerve allograft (PNA), has seen increased utilization in the reconstruction of traumatic nerve injuries. As these injuries are difficult to study, prospective clinical research on treatment algorithms are limited. Here we report our findings from a registry study on the outcomes of complex peripheral nerve injuries reconstructed using processed nerves allografts.
Methods: The RANGER registry is designed to continuously monitor and incorporate injury, repair, safety and outcomes data into a centralized database. The database was queried to identify a subset of patients with multi-tissue, high energy and extensive reconstructions. Outcomes from repairs reporting a minimum of 6 months quantitative data were evaluated for meaningful recovery, defined by the MRCC scale at S3/M3 or greater for sensory and motor function.
Results: Thirty subjects with 37 nerve injuries (25 sensory, 12 mixed/motor nerves) were identified in the database as having complex nerve reconstructions. The mechanisms of injury included: amputation (5), avulsion (9), crush avulsion (3), blast (3), crush (9), and gunshot (8). Their mean SD (minimum, maximum) age was 37 19 (19, 70). The mean gap length was 24 15 (8, 65) mm and the time-to-repair was 23 75 (0,456), with median time of 1 day. Overall meaningful recovery was observed in 78% of all repairs with 80% in sensory and 75% in mixed/motor. Sensory outcomes reported6 (S3), 9 (S3+), and 7 (S4) and motor outcomes reported 4 (M3), 2 (M4), and 1 (M4+). The mean static 2-PD was 9 4 mm. There were no reported nerve adverse events. Outcomes were comparable to those reported in the historical literature.
Conclusion: We found processed nerve allografts performed well when utilized in complex reconstructions of the upper extremity. Quantitative data demonstrate meaningful recovery in 78% of these cases. The Ranger Registry remains ongoing. Additional data collected will allow for further data analysis.

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