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Outcomes of Allograft Nerve Reconstruction in the Upper Extremity: A Five-Year Review
Corinne Wee MD, Leila Katabi BS, Kara McConaghy BS, Cristin Coquillard MD, Mona Ascha MD, B. Todd Bafus MD, Adrienne Lee MD, Kyle Chepla MD
Cleveland Clinic Foundation
2022-01-15
Presenter: Corinne Wee
Affidavit:
This project represents the original work of the submitting resident.
Director Name: Steven Bernard MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Upper extremity peripheral nerve injuries can lead to significant functional and financial burden. Nerve allografts allow surgeons to reconstruct large nerve gaps without donor site morbidity. The aim of this study was to evaluate the outcomes of nerve reconstruction using allograft in the upper extremity and assess which factors may influence these outcomes.
Methods: This is a retrospective review of all patients who underwent upper extremity peripheral nerve reconstruction with allograft by three surgeons from 2015-2019. Clinical documentation from surgeons and occupational therapists was used to determine patient outcomes. Outcomes were graded using the Medical Research Council Classification scale.
Results: Eighty-six nerve repairs in seventy-eight patients met inclusion criteria. Mean follow-up time was 223 days (range 31-1400 days). Fifty-one patients suffered a sensory only injury and achieved a mean sensory score of 2.3 +/- 1.2 Thirty-five patients suffered mixed injuries and had mean sensory and motor scores of 1.5 +/- 1.3 and 2.2 +/- 1.7, respectively. Overall, 50% of patients achieved a motor score of 3 or greater, and 42% of patients achieved a sensory score of 3 or greater. Shorter tourniquet time was predictive of higher motor and sensory scores (p=0.02, p=0.018). Patient age (p=0.08) and shorter operative time (p=0.09) were predictive of a higher sensory score but did not reach statistical significance.
Conclusion: Nerve allografts are a valuable addition to peripheral nerve repair techniques and can help patients with nerve injuries achieve improved function. However, this study demonstrates that they may have limitations in certain reconstructive settings.
