Utilizing Processed Nerve Allograft in Large Gap Peripheral Nerve Reconstruction in a Military Population
Marvin E Dingle, MD; Michael D Baird, MD; John Dunn, MD; Patricia E Mckay, MD; Leon J. Nesti, MD
Walter Reed National Military Medical Center, Bethesda, MD
Intro:
Extremity injuries are the most frequent injuries sustained in combat and peripheral nerve injuries represent one of the strongest predictors for separation from service.
While other studies have been published which define a role for acellular peripheral nerve allografts, out goal was to evaluate outcomes within a majority military population and which are necessitated by military unique injuries.
Method:
A retrospective review of 41 patients with various upper and lower extremity nerve injuries were treated at Walter Reed by two surgeons with 22 meeting inclusion criteria. These patients were a subst of patients included in the RANGER Study registry, an ongoing multicenter evaluation of processed nerve allografts(AvanceŽ Nerve Graft, AxoGen, Inc). These patients were followed up for as long as two years after surgery and data was collected to include MRCC scores at each follow up appointment with retrospective review completed on these charts.
Results:
Patients achieved improvement in 59% of cases as defined as improving from baseline MRCC scores measured prior to surgery. 27% of our patients achieved "meaningful recovery" which is defined as an MRCC score of M3 or S3 and above.
Conclusion:
Our reported results were not superior to those of other studies assessing processed nerve allografts. However, one distinguishing feature of our cohort was that we had by far the lowest mean age, and results in prior studies have shown that increased age is associated with improved outcomes.
These results represent a unique demographic when compared to other research, with a far younger and more severely injured patient population.
Our study also demonstrated the challenges of long term patient monitoring, particularly in those with complex injuries, and continued follow up of subjects treated with acellular nerve grafts may show even better results.
Our study reiterated that acellular nerve grafts are a safe and viable option in patients with peripheral nerve defects, offering hope to those who are devastated by large nerve gap injuries.
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