Outcomes after Long Gap Allograft Reconstruction in the Upper and Lower Extremities
Cameron Cox, BBA; Gracie R Baum, BS; Joash R Suryavanshi, MD; Bradley Osemwengie, MD; Desirae McKee, MD; Brendan J MacKay, MD
Texas Tech University Health Sciences Center, Lubbock, TX
Introduction Our understanding of processed nerve allograft (PNA) use in peripheral nerve repair is rapidly evolving. Favorable outcomes have been reported compared to autograft when used in the upper and lower extremity, as well as the facial nerve, for gaps up to 70 mm. While studies investigating the use of long autograft to reconstruct injuries of the brachial plexus have been published with mixed results, none have evaluated the use of long (>70 mm) allograft, as 70mm is the longest commercially available nerve allograft. We present short-term outcomes in long allograft repairs of peripheral nerve injuries.
Materials & Methods Retrospective review of patients from a single center who underwent peripheral nerve reconstruction with a long allograft was performed. Functional recovery, Tinel’s sign, and Semmes-Weinstein tests were recorded at follow-up visits. When possible, EMG and NCS were used to assess recovery. Complications and revision procedures were noted.
Results Twenty-five eligible patients were identified. Three patients were lost to follow-up and one patient later received an amputation for their original injury and was treated with targeted muscle re-innervation. Twenty-two patients (28 nerves) were included in our study, with an average age of 32 years (range: 6-66). Eighteen patients (82%) were male. Eighty-two percent (23/28) of reconstructed nerves were in the upper extremity, and the average gap length after nerve resection was 13.3cm (range: 7 – 38cm). All patients had multiple connected allografts used during their reconstructive procedure. Mean follow-up was 10.2 months.
All patients showed increased range of motion, functional recovery, and improved Tinel's sign and sensation at follow-up. Nine patients had EMG/NCS studies, and four had multiple EMG studies performed. On EMG (at an average 13.7 months postoperatively), all nine patients showed sensory recovery in the area of the reconstructed nerve, and four showed improved muscle activity signals in the motor unit of the reconstructed nerve. Nineteen patients received Semmes-Weinstein testing, all of which showed increased sensitivity compared to pre-surgical condition. No complications were noted in our cohort.
Conclusion All patients in our cohort had improved strength, sensation, and functional outcomes after long nerve allograft procedures and no complications or revision surgeries were indicated. Patients receiving EMG/NCS studies showed increased motor unit recruitment and/or improved sensation along the area of the reconstructed peripheral nerve. This retrospective review of patient outcomes after long-nerve allograft reconstruction suggests that long allograft may be a safe and effective procedure to repair severe segmental nerve defects.
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