Nerve allograft transplantation for functional restoration of the upper extremity: case series

Abstract

Background: Major trauma to the spinal cord or upper extremity often results in severe sensory and motor disturbances from injuries to the brachial plexus and its insertion into the spinal cord. Functional restoration with nerve grafting neurotization and tendon transfers is the mainstay of treatment. Results may be incomplete due to a limited supply of autologous material for nerve grafts. The factors deemed most integral for success are early surgical intervention, reconstruction of all levels of injury, and maximization of the number of axonal conduits per nerve repair. Objective: To report the second series of nerve allograft transplantation using cadaveric nerve graft and our experience with living-related nerve transplants. Participants: Eight patients, seven men and one woman, average age 23 years (range 18-34), with multi-level brachial plexus injuries were selected for transplantation using either cadaveric allografts or living-related donors. Methods: Grafts were harvested and preserved in the University of Wisconsin Cold Storage Solution at 5°C for up to 7 days. The immunosuppressive protocol was initiated at the time of surgery and was discontinued at approximately 1 year, or when signs of regeneration were evident. Parameters for assessment included mechanism of injury, interval between injury and treatment, level(s) of deficit, post-operative return of function, pain relief, need for revision surgery, complications, and improvement in quality of life. Results: Surgery was performed using living-related donor grafts in six patients, and cadaveric grafts in two patients. Immunosuppression was tolerated for the duration of treatment in all but one patient in whom early termination occurred due to non-compliance. There were no cases of graft rejection as of most recent followup. Seven patients showed signs of regeneration, demonstrated by return of sensory and motor function and/or a migrating Tinel's sign. One patient was non-compliant with the post-operative regimen and experienced minimal return of function despite a reduction in pain. Conclusions: Despite the small number of subjects, it appears that nerve allograft transplantation may be performed safely, permitting non-prioritized repair of long-segment peripheral nerve defects and maximizing the number of axonal conduits per nerve repair. For patients with long, multi-level brachial plexus injuries or combined upper and lower extremity nerve deficits, the use of nerve allograft allows a more complete repair that may translate into greater functional restoration than autografting alone.

ω-3 Polyunsaturated Fatty Acids Facilitate the Repair of Peripheral Nerve Defects with Chemically Extracted Acellular Allograft in Rats

“…This result suggests the Omega-3 PUFAs could be adopted to repair and reconstruct the large periphery nerve defect. However, the therapeutic potency of ACA with the aid of Omega-3 PUFAs still could not reach the efficiency of AU which was in accordance with previous reports suggesting the Omega-3 PUFAs hold finite value for neural growth [ 21 ]. In view of this situation, multiple approaches should be undertaken to compensate for the deficiency of each one for achieving the greatest benefits in managing nerve injury.…”

Regenerative Potential of Platelet-Rich Fibrin Releasate Combined with Adipose Tissue–Derived Stem Cells in a Rat Sciatic Nerve Injury Model

“…In some cases, nerve injuries requiring surgical repair may lead to permanent impairment of motor and sensory functions 3 . The surgical approaches rely on methods such as surgery and conduit connection 4 , including end-to-end anastomosis, end-to-side anastomosis, allogeneic nerve transplantation 5 , autologous nerve transplantation 6 , and nerve lengthening 7 . Nowadays autologous nerve transplantation is the gold standard for the treatment of peripheral nerve defects 6 .…”

“…However, it has some limitations regarding the secondary surgery to obtain the donor nerve: limited donor nerve sources, donor-site infections, and/or painful neuroma formation 8 . The limited sources of donor nerve will provide long segments for grafting without significant sensory losses 5 .…”

Treatment Trends of Adult Brachial Plexus Injury: A Bibliometric Analysis

“…The aim of both experimental studies was to use nerve allografts in the clinical scenario, and both studies showed that nerve allograft transplantation may be performed safely when the patients are carefully selected and screened. 21 , 22 …”