Avive Soft Tissue Membrane Improves Outcomes After Revision Upper - Extremity Nerve Decompression Surgery
Joash R Suryavanshi, BA, Christian Douthit, MD, Cameron Cox, BA, Ashley Maveddat, BA, Desirae McKee, MD and Brendan J MacKay, MD, Texas Tech University Health Sciences Center, Lubbock, TX
Introduction
The literature shows that results of revision nerve decompressions in the upper extremity are variable, ranging from 33-100% success. Avive® Soft Tissue Membrane is processed human umbilical cord membrane intended for use as a soft tissue covering, which may reduce inflammation and scarring, thereby improving tissue gliding. While the use of other synthetic nerve conduits have been shown to have variable outcomes for revision nerve decompression surgery in the upper extremity, the use of Avive® Membrane during revision carpal and cubital tunnel release has not been extensively studied.
Materials & Methods
We performed a retrospective review of patients that underwent revision surgeries for nerve decompression procedures in the upper extremity, including but not limited to carpal, cubital, and radial tunnel revision procedures, in which the Avive® Membrane was applied to the affected nerves to prevent scar adhesion formation. Patients were excluded if age < 18 or patient had previous trauma or medical condition damaging the nerve of interest. Patient reported pain (VAS), static 2-point discrimination, Tinel's sign, pinch strength, grip strength, range of motion (ROM), and patient satisfaction were recorded pre- and post-operatively. Patient demographic data, time from original surgery to revision surgery, total follow-up time, and length of Avive® usage were recorded.
Results
Seventeen patients met inclusion and exclusion criteria. Average age of patients was 57.3 (47-76). 41.2% of patients were male. Average time to revision surgery was 3.4 years and average time to follow up was 6.5 months. Eleven (65%), 5 (29%), and 1 (6%) of patients had Avive membrane placed on the median nerve, ulnar nerve, and radial nerve respectively. Pre-operative pain scores were measured for 13 patients, with a mean of 4.0. Average pain at the most recent follow up was 3.0, which was measured in 14 patients. ROM, static 2-Point discrimination, pinch and grip strength improved in 15 (88%) patients in our cohort. One (6%) patient noted no improvement following nerve revision at 6 month follow-up. 15 out of 17 (88%) patients reported improvement of preoperative symptoms. No complications were noted in our study cohort. Short-term data is promising and patients will continue to be followed and evaluated until 9 months postop.
Conclusions
This study demonstrates the utility of Avive® Membrane in revision nerve procedures of the upper extremity as documented by improvement in 88% of patients' preoperative symptoms.
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