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Allograft Nerve Reconstruction for Digital Nerve Loss
John S. Taras, MD1; Kimberlly Chhor, MD2; Mark Rekant, MD3
1The Philadelphia Hand Center, PC, Philadelphia, PA; 2Hand Surgery Fellow, The Philadelphia Hand Center, Philadelphia, PA; 3The Philadelphia Hand Center, Philadelphia, PA

Introduction: This prospective study evaluated the clinical and functional outcomes of allograft in digital nerve reconstruction.

Materials and Methods: Following institutional review board approval, we prospectively followed patients greater than 18 years of age with digital nerve lacerations not amenable to primary repair.  Nerve reconstruction was performed using decellularized allograft. Sixteen patients with 20 nerve reconstructions met the inclusion criteria. One surgeon performed all of the nerve reconstructions. Outcome data was collected by one independent observer. Postoperative sensory examination measures included Semmes-Weinstein monofilament testing, static (S2PD) and moving (M2PD) 2-point-discrimination, and The Quick Dash Outcome Measure.  

Results: Sixteen patients with 20 digital nerve lacerations underwent digital nerve allograft reconstruction. Three patients with 3 digital nerves were lost to follow-up, thus, the study cohort included 13 patients with 17 digital nerve reconstructions. Average patient age was 37 years (range, 18-57 years). The average time to surgery was 29 days after injury (range, 2-262 days). The average nerve defect measured 1.2 cm (range, 0.5 -3.0 cm).

The average duration of final follow-up was 13 months (range, 5 -20 months). At final follow-up, S2PD averaged 8.71 mm (range, 7-15 mm) and M2PD averaged 7.06 mm (range, 5-18 mm).  Semmes-Weinstein monofilament testing averaged 4.06 (range, 3.22-6.65).  Initial Quick Dash scores averaged 44.8 (range, 2.3-79.5), and final Quick Dash scores averaged 26.1 (range, 2.3 - 43.2). There were no infections, extrusion, or graft reaction. One patient underwent additional surgery for a 2-stage tendon reconstruction.

Discussion: The use of allograft nerve offers a safe, simple method of digital nerve reconstruction with outcomes comparable to vein graft and conduit.

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