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Comparisons of Functional Recovery Outcomes Between Processed Nerve Allograft and Hollow Tube Conduits for Short and Long Gap Digital Nerve Repairs
Bauback Safa, MD1, Jason Ko, MD2; Mitchell Pet, MD2; Harry Hoyen, MD3; Wesley Thayer, MD, PhD4; Gregory Buncke, MD1
1The Buncke Clinic, San Francisco, CA; 2University of Washington, Harborview Medical Center, Seattle, WA; 3Metro Health Medical Center, Cleveland, OH; 4Vanderbilt University, Nashville, TN

Introduction: Processed nerve allograft and tube conduit both offer convenient options for digital nerve gap repair. Despite their wide availability, no consensus exists as to the optimal treatment gap length. To evaluate for potential differences in recovery outcomes with theses repair methods, we queried a national nerve registry for digital nerve repairs 30mm or less repaired with processed nerve allograft or tube conduit. Here we report our findings on the functional in digital nerve repairs for two gap length groups, gaps ?14mm and 15-23mm.

Methods: The RANGER registry is an active database designed to collect outcomes data for processed nerve allografts (AvanceŽNerve Graft, AxoGen, Inc), tube conduits, and nerve autograft. The database was queried for digital nerve injuries with gaps up to 30mm with a minimum of 5 months of quantitative follow-up. Complex injuries such as amputations, avulsions, gunshots/blast injuries were excluded from the dataset to minimize confounding variables. The dataset was stratified into two gap length groups, gaps ?14mm and15-30mm. Meaningful sensory recovery was defined by the MRCC scale at S3 or greater. Comparisons of meaningful recovery outcomes were completed by repair method between and across the gap length groups.

Results: Four RANGER sites contributed data for both types of repairs. The dataset consisted of 41 subjects with 70 injuries. The ? 14mm gap group consisted of 22 PNA and 8 conduit repairs. The 15-30mm gap group consisted of 24 PNA and 16 conduit repairs. Subject demographics and repair characterizes were comparable between treatment groups. Saw type lacerations were the most common mechanism of injury in both groups. In the ?14mm gap group, PNA and conduit reported 95% and 75% meaningful recovery respectively. In the 15-30mm gap length group, PNA and conduit reported 83% and 31% recovery respectively (p<0.05) with four revisions reported in the conduit group. See Table 1. There were no reported adverse events.

Conclusion: Processed nerve allografts performed consistently well while the quality of recovery with conduit decreased as gap length increased. Conduits reported a statistically significant difference by gap length with < 14mm repairs reporting more consistent levels of recovery as compared to gaps 15mm or greater. Data from this study should be considered when designing future studies. The RANGER registry remains ongoing; additional clinical data collected from participating sites will allow for further comparisons of PNA to conduit.

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