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Recovery Outcomes of Short Gap Sensory Nerve Repairs with Processed Nerve Allografts from a Multi-center Registry Study
Brian Rinker, MD1; Renata V. Weber, MD2; John Ingari, MD3; Bauback Safa, MD4; Darrell Brooks, MD4; Gregory M. Buncke, MD4;
1University of Kentucky, 2Institute for Nerve, Hand, and Reconstructive Surgery, 3WellSpan Health Orthopedics, 4The Buncke Clinic
Digital nerve transections often result in small gaps, especially following adequate debridement of the affected area. To better understand the expected outcomes following reconstruction of nerve injuries with processed nerve allograft, a multicenter study of these grafts was undertaken in 2008. Between 2010 and 2011, the second data milestone was enrolled to expand the number of contributing surgeon and nerve injuries. This expanded database was queried and analyzed to determine the frequency and outcomes of nerve gap reconstructions between 5-15 mm with processed nerve allograft.
The current RANGER registry, consisting of 16 centers with 32 surgeons, is designed to continuously monitor and incorporate injury, repair, safety and outcomes data using standardized case report forms. Centers followed their own standard of care for treatment and follow-up. Completed analysis resulted in a database of 143 subjects with 188 nerve repairs. The database was queried for digital nerve injuries with a gap between 5-15mm reporting sufficient follow-up data (2mm/day) to complete outcomes analysis. Available quantitative and qualitative outcome measures were reviewed and reported. Meaningful recovery was defined by the MRCC scale at S3-S4 for sensory function. Quantitative assessment included: MRCC scale for sensory, 2-point discrimination (2-PD), Semmes-Weinstein Monofilaments (SWMF), and pain assessments.
Sufficient quantitative follow-up data was available for 15 subjects with 17 digital repairs in the gap range of 5-15mm. The mean ±SD (minimum, maximum) age was 43±13 (23-70). The mean gap was 10±2 (5-14) mm. The mean time to repair was 10±29 (0-120) days. There were 11 lacerations, 3 avulsion/amputations, 1 gunshot, and 2 crush injuries. Meaningful recovery, defined as S3-S4 on the MRCC scales, was reported in 100% of the repairs. If held to higher recovery classification, S3+-S4, outcomes were observed in 93% of repairs. Static 2PD was 7±2.7 mm (n=11). Return to light touch was observed in 7 out of 8 repairs reporting SWMF. There were no reported nerve adverse events.
We found that processed nerve allografts performed very well in short gap reconstructions for digital nerves in the hand. The use of processed nerve allograft allowed for tensionless repair permitting for full extension of the hand after reconstruction. These outcomes compared favorably to historical controls for nerve autograft and exceed that of tube conduit. Continuation of this registry will provide confirmatory clinical data into expected outcomes of processed nerve allograft for short gap reconstructions.
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