Analysis of human acellular nerve allograft reconstruction of 64 injured nerves in the hand and upper extremity: a 3 year follow-up study

Abstract

Human acellular nerve allografts have been increasingly applied in clinical practice. This study was undertaken to investigate the functional outcomes of nerve allograft reconstruction for nerve defects in the upper extremity. A total of 64 patients from 13 hospitals were available for this follow-up study after nerve repair using human acellular nerve allografts. Sensory and motor recovery was examined according to the international standards for motor and sensory nerve recovery. Subgroup analysis and logistic regression analysis were conducted to identify the relationship between the known factors and the outcomes of nerve repair. Mean follow-up time was 355 ± 158 (35-819) days; mean age was 35 ± 11 (14-68) years; average nerve gap length was 27 ± 13 (10-60) mm; no signs of infection, tissue rejection or extrusion were observed among the patients; 48/64 (75%) repaired nerves experienced meaningful recovery. Univariate analysis showed that site and gap length significantly influenced prognosis after nerve repair using nerve grafts. Delay had a marginally significant relationship with the outcome. A multivariate logistic regression model revealed that gap length was an independent predictor of nerve repair using human acellular nerve allografts. The results indicated that the human acellular nerve allograft facilitated safe and effective nerve reconstruction for nerve gaps 10-60 mm in length in the hand and upper extremity. Factors such as site and gap length had a statistically significant influence on the outcomes of nerve allograft reconstruction. Gap length was an independent predictor of nerve repair using human acellular nerve allografts. Copyright © 2016 John Wiley & Sons, Ltd.

Surgical Treatment of Abdominal Wall Neuromas

“…Nerve allografts are well described in the treatment of neuroma pain in the upper and lower extremity. 7 , 31 , 32 Of note, processed nerve allografts have been shown to be effective for nerve reconstruction of gaps up to 3 cm, 33 – 36 and all of our cases used an allograft this length or shorter. Based on the senior author’s experience for painful nerves in the groin and the extremities, TMR is a more effective pain treatment than allograft reconstruction, and so the inguinal area now receives this procedure preferentially.…”

Validation of a Cleanroom Compliant Sonication-Based Decellularization Technique: A New Concept in Nerve Allograft Production

“…Isaacs and coworkers [14] have implanted ANAs in combination with nerve connectors in rats and Hong and coworkers [15] have successfully tested ANAs in an animal setting for such a challenging problem as painful neuroma. ANAs were also efficaciously employed in a clinical context for human trigeminal nerve [16] and upper extremities reconstructions [17] and they have been successfully utilized for brachial plexus reconstruction by Li and collaborators [18].…”

Controlling axonal regeneration with acellular nerve allograft limits neuroma formation in peripheral nerve transection: An experimental study in a swine model

“…Though still a matter of controversy, most authors recommend allograft nerve interposition grafting for segmental defects less than 5 cm in length (Brooks et al, 2012; Griffin et al, 2013; Hoben et al, 2018; Rbia & Shin, 2017; Safa & Buncke, 2016). While good to excellent outcomes have been reported for segmental defects <3 cm, worse results have been reported in longer grafts, both allograft and autograft (Hoben et al, 2018; Leckenby et al, 2020; Zhu et al, 2017). Although the limitations of allograft nerve to bridge large segmental defects remains a topic of continued research, this characteristic may be beneficial when axonal growth arrest is desired.…”