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Outcomes of Sensory Nerve Repair: Sub-group Analysis from a Multicenter Study on Processed Nerve Allografts
Darrell Brooks, MD
The Buncke Clinic, San Francisco , CA

Introduction: The return of sensation following nerve injury can have profound improvements in patients’ quality of life.  Transected sensory nerves are one of the most common nerve repairs performed by hand surgeons. When the nerve gap is insurmountable, a bridging material is needed to reconstruct the deficit.  Several treatment alternatives to the classic nerve autograft are available to the surgeons.  However, limited clinical data has been published on expected safety and outcomes.  We have undertaken a multicenter study exploring in depth the safety and outcomes from the use of  processed nerve allografts (Avance® Nerve Graft, AxoGen Inc.) with a goal of providing a better understanding of the role processed nerve allografts play in the surgeon’s armamentarium.   

Methods: Twelve sites with 25 surgeons contributed 132 individual nerve injuries over a two year period.  IRB approval was obtained and standardized case report forms were used to collect utilization and follow-up data. Follow-up evaluations for recovery included the MRCC scale for sensory recovery, 2-point discrimination (2-PD), Semmes-Weinstein Monofilaments (SWMF), and qualitative questionnaires. Demographic and covariate analysis was performed to further characterize the sub-groups and  outcomes were assessed across the entire sub-population. 

Results: Sufficient data for outcomes analysis was available for 76 injuries.  In the sub-group analysis of sensory nerves, there were 37 subjects with 49 nerve repairs with sufficient outcomes data.  The mean ± SD (minimum, maximum) age was 41.4 ± 14 (18, 70). The mean gap was 18.8 ± 8 (5, 40) mm and average time-to-repair (TTR) was 182 ± 323 (0, 1460) days. The median TTR was 11 days.

Meaningful recovery, defined as S3-S4 on the MRCC scale, was demonstrated in 87% of the sensory nerve repairs reporting quantitative data.  Mean static 2-PD, reported in 23 of nerve repairs, was 8.2 ± 2.9 mm (4, 13). SWMF testing was conducted in 10 subjects with return to diminished light touch reported in 7 of the 10 nerve repairs.  No adverse experiences were reported, however one revision surgery was required due to complications from the original injury.

Conclusion: In this study, processed nerve allografts provided reliable safety and efficacy outcomes for sensory nerve repairs.  Sub-group analysis of quantitative endpoints demonstrates meaningful recovery in 87% of sensory repairs.  Continuation of this study will provide additional clinical data to further establish the expected outcomes around processed nerve allografts.

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