Functional Outcome Following Nerve Repair in the Upper Extremity Using Processed Nerve Allograft

Cho, Mickey S.; Rinker, Brian; Weber, Renata V.; Chao, Jerry; Ingari, John V.; Brooks, Darrell; Buncke, Gregory M.

doi:10.1016/j.jhsa.2012.08.028

Cited by 202 publications

(120 citation statements)

References 25 publications

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“…7,23 Furthermore, Cho et al used a multicenter registry on nerve allograft to report on 35 digital nerve repairs with a mean gap of 19 mm where 89% returned to S3 or and greater. 4 Outcomes reported in the literature for digital nerve repairs with conduits have varied widely. Investigator initiated studies with collagen conduits report positive outcomes as high as 89% to as low as 40%.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve

Means

Rinker

Higgins

et al. 2016

Hand (New York, N,Y.)

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Background: Current repair options for peripheral nerve injuries where tension-free gap closure is not possible include allograft, processed nerve allograft, and hollow tube conduit. Here we report on the outcomes from a multicenter prospective, randomized, patient-and evaluator-blinded, pilot study comparing processed nerve allograft and hollow conduit for digital nerve reconstructions in the hand. Methods: Across 4 centers, consented participants meeting inclusion criteria while not meeting exclusion criteria were randomized intraoperatively to either processed nerve allograft or hollow conduit. Standard sensory and safety assessments were conducted at baseline, 1, 3, 6, 9, and 12 months after reconstruction. The primary outcome was static 2-point discrimination (s2PD) testing. Participants and assessors were blinded to treatment. The contralateral digit served as the control. Results: We randomized 23 participants with 31 digital nerve injuries. Sixteen participants with 20 repairs had at least 6 months of follow-up while 12-month follow-up was available for 15 repairs. There were no significant differences in participant and baseline characteristics between treatment groups. The predominant nerve injury was laceration/sharp transection. The mean ± SD length of the nerve gap prior to repair was 12 ± 4 mm (5-20 mm) for both groups. The average s2PD for processed allograft was 5 ± 1 mm (n = 6) compared with 8 ± 5 mm (n = 9) for hollow conduits. The average moving 2PD for processed allograft was 5 ± 1 mm compared with 7 ± 5 mm for hollow conduits. All injuries randomized to processed nerve allograft returned some degree of s2PD as compared with 75% of the repairs in the conduit group. Two hollow conduits and one allograft were lost due to infection during the study. Conclusions: In this pilot study, patients whose digital nerve reconstructions were performed with processed nerve allografts had significantly improved and more consistent functional sensory outcomes compared with hollow conduits.

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Section: Discussionmentioning

confidence: 99%

A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve

Means

Rinker

Higgins

et al. 2016

Hand (New York, N,Y.)

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“…In fact, single exogenous dosage of BDNF has shown better results than continuous long-term applications [258]. It is reported that muscle regeneration causes the overexpression of GDNF which increases the number of motor axons in the neuromuscular junctions in vivo [259][260][261][262][263][264][265][266]. Also, GDNF is a potent protective factor against axotomy-induced motor and sensory neuron death [267][268][269][270].…”

Section: Neurotrophic Factorsmentioning

confidence: 99%

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

Pedrosa¹,

Caseiro²,

Santos³

et al. 2017

Scaffolds in Tissue Engineering - Materials, Technologies and Clinical Applications

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Human adult peripheral nerve injuries are a high incidence clinical problem that greatly affects patients' quality of life. Although peripheral nervous system has intrinsic regenerative capacity, this occurs in an incomplete or poorly functional manner. When a nerve fiber loses its continuity with consequent damage of the basal lamina tubes, axon spontaneous regeneration is disorganized and mismatched. These phenomena translate in an inadequate nerve functional recovery and consequent musculoskeletal incapacity. Nerve grafts still remain the gold standard in peripheral injuries treatment. However, this approach contains its disadvantages such as the necessity of primary surgery to harvest the autografts, loss of a functional nerve, donor site morbidity and longer surgery procedures. Therefore, biomaterials and tissue engineering can provide efficient resources and alternatives to nerve injury repair not only by the development of biocompatible structures but also, introducing neurotrophic factors and cellular systems to stimulate optimum clinical outcome. In this chapter, a comprehensive state-of-the art picture of tissue-engineered nerve grafts scaffolds, their application in nerve regeneration along with latest advances in peripheral nerve repair and future perspectives will be discussed, including our own large experience in this field of knowledge.

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“…(1,4,16) A recent review of the literature, however, disclosed few clinical studies evaluating the efficacy of processed allografts to reconstruct digital nerve defects in the hand. (14,17) In a retrospective review, Karabekmez et al (14) reported on the efficacy of processed allografts for restoring adequate sensation in nerve defects ranging from 5 to 30 mm. Cho et al (17) reported on a subset of digital nerve defects up to 40 mm from an ongoing nerve registry.…”

Section: Introductionmentioning

confidence: 99%

“…(14,17) In a retrospective review, Karabekmez et al (14) reported on the efficacy of processed allografts for restoring adequate sensation in nerve defects ranging from 5 to 30 mm. Cho et al (17) reported on a subset of digital nerve defects up to 40 mm from an ongoing nerve registry.…”

Section: Introductionmentioning

confidence: 99%

Allograft Reconstruction for Digital Nerve Loss

Taras¹,

Amin²,

Patel³

et al. 2013

The Journal of Hand Surgery

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Functional Outcome Following Nerve Repair in the Upper Extremity Using Processed Nerve Allograft

Cited by 202 publications

References 25 publications

A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve

A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

Allograft Reconstruction for Digital Nerve Loss

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