Use of Processed Human Nerve Allograft in Reconstruction of Brachial Plexus Birth Injuries
Aaron J Berger, MD, PhD1, Herbert Valencia, RNFA2, Andrew Price, MD2,3 and John A.I. Grossman, MD2, (1)Division of Plastic and Reconstructive Surgery, Nicklaus Children's Hospital, Miami, FL, (2)Nicklaus Children's Hospital, Miami, FL, (3)NYU Hospital for Joint Diseases, New York, NY
Purpose
To describe our experience with the use of processed human nerve allograft in the reconstruction of brachial plexus birth injuries.
Introduction
Although the standard approaches to reconstruction of defects in the brachial plexus include sensory nerve autografts and nerve transfers, the availability of processed decellularized nerve allograft presents another option, which may be used in lieu of, or in addition to nerve autografts and nerve transfers.
Methods
The study design consisted of a retrospective review of the medical records of patients who underwent brachial plexus reconstruction that involved the use of processed human nerve allograft at our hospital from April 2012 to October 2013. Thirteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the senior author.
Results
The participants ranged in age from 6 to 12 months. Of the 13 patients, 7 were female (54%) and 6 were male (46%). 7 were affected on the left (54%) and 6 were affected on the right (46%). 9 patients sustained upper plexus (Erb's) injuries (69%); 2 patients sustained extended Erb's injuries (15%) and 2 patients sustained global injuries (15%). 7 patients underwent concomitant spinal accessory to suprascapular nerve transfer (54%). Concomitant autograft was used in 5 cases: sural nerve autograft was used for reconstruction in 4 cases (31%) and cervical plexus autograft was used in 1 case (8%).
The number of processed nerve allografts used in each case ranged from 1-2; two patients each received 2 grafts. The length of processed nerve allograft ranged from 3.0-4.7cm with average length of 4.2cm. The allograft was placed in an end-to-end fashion in 4 cases (31%) and end-to-side fashion in 9 cases (69%). The donor signal was obtained from the C5 and/or C6 nerve roots and the recipient sites included the suprascapular nerve, anterior and posterior divisions of the upper trunk and the middle trunk.
Conclusions
Although the observed recovery in many of the patients cannot be exclusively attributed to the use of processed nerve allograft, the results of the present study suggest that processed nerve allografts may be used in a supplemental fashion in reconstruction of brachial plexus birth injuries.
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