Outcomes after Long Gap Allograft Reconstruction in the Upper and Lower Extremities
Cameron Cox, BBA1, Joash R Suryavanshi, BA1, Bradley Osemwengie, BA1, Nancy E Swinford, R.T. (R)(ARRT), CCRC2, Matthew Blue, MD1, Desirae McKee, MD1 and Brendan J MacKay, MD1, (1)Texas Tech University Health Sciences Center, Lubbock, TX, (2)Texas Tech University Health Science Center, Lubbock, TX
Introduction
Our understanding of the use of processed nerve allograft (PNA) in peripheral nerve repair is rapidly evolving. Favorable outcomes have been reported compared to autograft when used in the upper and lower extremity, as well as the facial nerve, for gaps up to 70 mm. While studies investigating the use of long autograft to reconstruct large injuries of the brachial plexus injuries have been published with mixed results, none have evaluated the use of long (>100 mm) allograft, as 70mm is the longest commercially available nerve allograft. We present short-term outcomes in long allograft repairs of peripheral nerve injuries.
Materials & Methods
Retrospective review of patients from a single center who underwent peripheral nerve reconstruction with a long allograft was performed. Functional recovery, Tinel's sign, and Semmes-Weinstein tests were recorded at follow-up visits. When possible, EMG and NCS were used to assess recovery. Complications and revision procedures were noted.
Results
Fourteen eligible patients were identified. Three patients were lost to follow-up and one patient later received and amputation for their original injury and was treated with targeted muscle re-innervation. Ten patients were included in our study, with an average age of 31 years (range: 21-41). Eight patients (80%) were male. Ninety percent of reconstructed nerves were in the upper extremity, and the average gap length after nerve resection was 17 cm (range: 7.5 - 36). All patients had multiple connected allografts used during their reconstructive procedure. Mean follow-up was 14.2 months.
All patients showed increased range of motion (ROM), functional recovery, and improved Tinel signs and sensation at follow-up. Nine patients had EMG/NCS studies, and 4 patients had multiple EMG studies performed. On EMG, all 9 patients showed sensory recovery in the area of the reconstructed nerve, and 4 patients showed improved muscle activity signal in the motor unit of the reconstructed nerve. Seven patients also received Semmes Weinstein testing, all of which showed increased sensitivity compared to presurgical condition. No complications were noted in our study cohort.
Conclusion
All patients in our cohort had improved strength, sensation, and functional outcomes after long-nerve allograft procedures and no complications or revision surgeries were indicated. Patients receiving EMG/NCS studies showed increases motor unit recruitment and improved sensation along the area of the reconstructed peripheral nerve. This retrospective review of patient outcomes after long-nerve allograft reconstruction suggests that long allograft may be a safe and effective procedure to repair severe nerve resections.
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