Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft

Bauback Safa, MD; Jaimie T. Shores, MD; John V. Ingari, MD; Renata V. Weber, MD; Mickey Cho, MD; Jozef Zoldos, MD; Timothy R. Niacaras, MD, PhD; Leon J. Nesti, MD, PhD; Wesley P. Thayer, MD, PhD; Gregory M. Buncke, MD

doi:10.1097/GOX.0000000000002163

Plastic and Reconstructive Surgery, Global Open (Mar 2019)

Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft

Bauback Safa, MD,
Jaimie T. Shores, MD,
John V. Ingari, MD,
Renata V. Weber, MD,
Mickey Cho, MD,
Jozef Zoldos, MD,
Timothy R. Niacaras, MD, PhD,
Leon J. Nesti, MD, PhD,
Wesley P. Thayer, MD, PhD,
Gregory M. Buncke, MD

Affiliations

Bauback Safa, MD: From the *The Buncke Clinic, San Francisco, Calif.
Jaimie T. Shores, MD: †Department of Plastic Surgery, Johns Hopkins University, Baltimore, Md.
John V. Ingari, MD: ‡Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Md.
Renata V. Weber, MD: §Multi-Disciplinary Specialists, Rutherford, N.J.
Mickey Cho, MD: ¶Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex.
Jozef Zoldos, MD: ‖Arizona Center for Hand Surgery, Phoenix, Ariz.
Timothy R. Niacaras, MD, PhD: **Department of Orthopedic Surgery, JPS Health Network, Fort Worth, Tex.
Leon J. Nesti, MD, PhD: ††Walter Reed National Military Medical Center, Clinical and Experimental Orthopaedics, Uniformed Services University, Bethesda, Md.
Wesley P. Thayer, MD, PhD: ‡‡Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Gregory M. Buncke, MD: From the *The Buncke Clinic, San Francisco, Calif.

DOI: https://doi.org/10.1097/GOX.0000000000002163
Journal volume & issue: Vol. 7, no. 3
p. e2163

Abstract

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Background:. Severe trauma often results in the transection of major peripheral nerves. The RANGER Registry is an ongoing observational study on the use and outcomes of processed nerve allografts (PNAs; Avance Nerve Graft, AxoGen, Inc., Alachua, Fla.). Here, we report on motor recovery outcomes for nerve injuries repaired acutely or in a delayed fashion with PNA and comparisons to historical controls in the literature. Methods:. The RANGER database was queried for mixed and motor nerve injuries in the upper extremities, head, and neck area having completed greater than 1 year of follow-up. All subjects with sufficient assessments to evaluate functional outcomes were included. Meaningful recovery was defined as ≥M3 on the Medical Research Council scale. Demographics, outcomes, and covariate analysis were performed to further characterize this subgroup. Results:. The subgroup included 20 subjects with 22 nerve repairs. The mean ± SD (minimum–maximum) age was 38 ± 19 (16–77) years. The median repair time was 9 (0–133) days. The mean graft length was 33 ± 17 (10–70) mm with a mean follow-up of 779 ± 480 (371–2,423) days. Meaningful motor recovery was observed in 73%. Subgroup analysis showed no differences between gap lengths or mechanism of injury. There were no related adverse events. Conclusions:. PNAs were safe and provided functional motor recovery in mixed and motor nerve repairs. Outcomes compare favorably to historical controls for nerve autograft and exceed those for hollow tube conduit. PNA may be considered as an option when reconstructing major peripheral nerve injuries.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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