Long Nerve Autograft Reconstruction Outcomes in the Lower Extremity, Proximal and Distal Upper Extremity
Matthew D Ramsey, MD1, Joshua P Weissman, BBA2, Justin P Cruz, BSE2, Gregory A Dumanian, MD2 and Jason H Ko, MD, MBA2, 1Northwestern Memorial Hospital, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Chicago, IL
Purpose: Despite being the gold standard in autologous nerve reconstruction, autografts longer than 6 centimeters have historically had poor results. Our study sought to determine factors associated with acceptable vs suboptimal clinical outcomes in patients requiring long autograft nerve reconstruction.
Methods: A retrospective chart review was conducted of two surgeons’ peripheral nerve autograft reconstructions greater than or equal to 6 cm in length from 2015 to 2021. Variables collected included age, comorbidities, injured nerve, anatomic location of injury, length of nerve defect requiring reconstruction, and follow-up time. Patients were categorized into “acceptable” and “suboptimal” outcomes based on patient testimonials, daily functional ability, and surgeons’ exam findings at time of last follow-up. Statistical analysis was performed using Student’s t-test and Chi Square test as appropriate.
Results: A total of 21 patients were included accounting for a total of 31 autologous nerve grafts with a mean graft length of 8.5 cm (maximum length grafted 18 cm). The most common nerve reconstructed in the upper extremity was a brachial plexus trunk or cord (36%) with the superficial peroneal nerve (43%) being the most common in the lower extremity. Overall, a motor vehicle collision (MVC) (38%) was the most common event necessitating nerve reconstruction. In total, 19 patients had sufficient follow-up data to have their results classified. Eleven (58%) patients were found to have an acceptable functional outcome, achieving functional status for activities of daily living, at least anti-gravity motor strength and no pain.
Conclusion: Our series of 31 such grafts performed over a six-year period demonstrate that recovery potential is relatively low for this patient population, further limited by the frequent need for multiple simultaneous grafts and high-energy mechanisms of injury. This data may help guide patient selection and counseling when undertaking nerve reconstruction while considering other treatment modalities.
Level of Evidence: IV
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