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Back to 2017 Scientific Program ePosters
Outcomes from Peripheral Nerve Repair Using Processed Nerve Allograft Combined with Nerve Protectors
Jozef Zoldos, MD1; Bauback Safa, MD2; Timothy R Niacaris, MD, PhD3; Renata V Weber, MD4; Mickey Cho, MD5; Gregory M. Buncke, MD2
1Arizona Center for Hand Surgery, Phoenix, AZ, 2The Buncke Clinic, San Francisco, CA, 3UNT Health Science Center, Fort Worth, TX, 4Institute for Nerve, Hand, and Reconstructive Surgery, Rutherford, NJ, 5Orthopedics, San Antonio Military Medical Center, San Antonio, TX
Introduction: Nerve protectors have been shown in the literature to decrease perineural scar formation, fascicular misalignment, and axonal escape after nerve repairs. This protective environment may improve recovery outcomes, especially in certain high risk cases such as complex injury and mixed/motor nerve gaps. The aim of this study is to report clinical outcome data on the utilization of nerve protectors in conjunction with processed nerve allograft (PNA) to repair gap nerve injuries.
Methods: Clinical data were retrieved from the RANGER registry, an ongoing database designed to collect outcomes data for processed nerve allografts (Avance® Nerve Graft, AxoGen, Inc). The database was queried for mixed, motor, and sensory nerve injuries in the upper extremity repaired with PNA followed by nerve protection of the coaptation sites. The cohort was further stratified into time to repair, nerve type, and mechanism of injury subgroups. Reported outcomes data were incorporated into the MRCC scale for sensory and motor function. Meaningful recovery was defined as ≥ S3/M3 on the MRCC scale.
Results: The cohort consists of 37 subjects with 46 repairs (29 mixed, 9 motor, and 8 sensory nerve injuries), among which 19 repairs used protectors and 27 repairs were PNA alone. Mean gap length was 34 ±14 mm and 29 ±11 mm for PNA with protectors and PNA only group (P=0.27, t test), respectively. Distribution of time to repair and nerve type was largely balanced between the groups. Meaningful recovery was observed in 89% and 79% of repairs in the PNA with protectors and PNA only group (P=0.26, Fisher's exact test), respectively. No significant difference was found in the mean age and follow-up length between two groups. See Table 1. No adverse events were reported.
Conclusion: Nerve protectors can create an environment to prevent the potential of soft tissue attachments and reduce axonal escape. Further they may reduce the technical challenges associated with end-to-end repair such as fascicular misalignment and overtightening. In our study, both PNA with protectors and PNA alone resulted in functional recovery comparable to historical outcomes with nerve autograft. While not significant, meaningful recovery trended higher in the PNA with protector group. Limitations of this study include the small sample size and heterogeneous dataset. Additional studies are needed to provide further data on the role of nerve protectors in peripheral nerve repair.
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