Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive^™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity

Abstract

Background: Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane. Methods: We performed a prospective, single-center pilot study of patients undergoing multi-level surgical reconstruction for exposed, non-transected peripheral nerve. Functional outcomes including pain, range of motion, pinch and grip strength, and the QuickDASH and SF-36 patient-reported outcome measures were recorded, when possible, at the 1-week and 3, 6, and 9 months postop visit. One-tailed paired t-tests were performed to evaluate outcome improvement at final follow-up. Results: Twenty patients had processed human umbilical cord membrane placement without surgical complications. Mean follow-up was 7.5 months (range: 3–10 months) and mean age was 39 years (range: 15–65). Twelve (67%) patients were male, and the majority of placement sites were in the upper extremity (85%). Mean preoperative visual analog scale pain score was significantly reduced at most recent follow-up, as were QuickDASH scores. All patients had improved functional outcomes at the 9-month follow-up, and SF-36 outcomes at 9 months showed improvement across all dimensions. Conclusion: This study indicates that processed human umbilical cord membrane may be a useful adjunct in nerve surgery with noted improvements in postoperative function, pain, and patient-reported outcome measures. Future studies are needed to assess long-term outcomes after traumatic nerve injury treated with processed human umbilical cord membrane.

Avive Soft Tissue Membrane Improves Outcomes of Revision Upper-extremity Nerve Decompression Surgery

“…Pain is often considered the most important outcome measure as it can affect multiple other elements of functional recovery. 11 Clinically important changes in pain have been defined as a reduction of more than two points on the VAS or 30% reduction from preoperative pain. 47 Our cohort demonstrated a higher rate of clinically significant pain reduction (>2 point reduction) in the Avive PUCM group (64.9%) compared with controls (40.8%) ( Supplemental Digital Content 2, http://links.lww.com/PRSGO/C426 ).…”

“…Although Avive has recently been used to wrap exposed or damaged nerves, its role in revision carpal, cubital, and radial tunnel decompression has not been extensively studied. 11 We designed the present study to evaluate the clinical utility of the Avive PUCM in upper-extremity revision nerve decompression.…”

Use of Nerve Wraps in the Upper Extremity

“…[1][2][3] Multiple nerve wraps include vein wrapping, adipofascial or muscle flaps, bovine collagen wraps, porcine small intestine submucosal wraps, human umbilical cord membranes, and synthetic collagen products. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The ideal nerve wrap would illicit minimal inflammatory reaction, allow nutrient diffusion without axonal escape, avoid scar-induced nerve ischemia, and promote nerve gliding without any donor site morbidity and with minimal cost. 3 One commercially available nerve wrap is the Axo-Guard™ (Axogen, Alachua, USA) porcine extracellular matrix (PEM) nerve wrap, which is derived from small intestine submucosal and composed of collagen fibronectin, growth factors, glycosaminoglycans, proteoglycans, and glycoproteins.…”