Nerve regeneration across cryopreserved allografts from cadaveric donors: a novel approach for peripheral nerve reconstruction

Abstract

Object The use of allografts from cadaveric donors has attracted renewed interest in recent years, and pretreatment with cryopreservation and immunosuppression methods has been investigated to maximize axonal regrowth and minimize allograft rejection. The authors wanted to assess the outcome of treatments of brachial plexus stretch injuries with cryopreserved allografts from cadaveric donors in nonimmunosuppressed patients. Methods Ten patients with brachial plexus lesions were submitted to electromyography (EMG) testing 1 and 3 months after a traumatic event and 1 week before surgery to localize and identify the type of lesion. Intraoperative EMG recordings were performed for intraoperative monitoring to select the best surgical strategy, and postoperative EMG was used to follow up patients and determine surgical outcomes. If nerve action potentials (NAPs) were present intraoperatively, neurolysis was performed, whereas muscular/nerve neurotization was performed if NAPs were absent. Cryopreserved allografts obtained from selected cadaveric donors and provided by the tissue bank of Treviso were used for nerve reconstruction in patients who were not treated with immunosuppressive drugs. Results The surgical strategy was selected according to the type and site of the nerve lesion and on the basis of IOM results: 14 cryopreserved allografts were used for 7 muscular neurotizations and for 7 nerve neurotizations, and 5 neurolysis procedures were performed. All of the patients had regained motor function at the 1- and 2-year follow-ups. Conclusions Some variables may affect functional recovery after allograft surgery, and the outcome of peripheral nerve reconstruction is more favorable when patients are carefully evaluated and selected for the surgery. The authors demonstrated that using cryopreserved allografts from cadaveric donors is a valid surgical strategy to restore function of the damaged nerve without the need for any immunosuppressive treatments. This approach offers new perspectives on procedures for extensive reconstruction of brachial and lumbosacral plexuses.

The amnion muscle combined graft (AMCG) conduits: A new alternative in the repair of wide substance loss of peripheral nerves

“…Conversely, the use of fresh allografts for repairing wide nerve gaps, requires immune suppression, while the use of processed nerve allografts (ECM decellularized and cleansed nerve graft), or cryopreserved allografts without any immunosuppressive treatment, still needs of a longer follow up to assess their real efficacy.…”

Decellularized Nerves for Upper Limb Nerve Reconstruction: A Systematic Review of Functional Outcomes

“…By crosschecking the references of the six articles, we found one additional article, making a total of seven studies. [11][12][13][14][15][16][17] Given the novelty of the method, the first study on decellularized nerve use in a clinical setting was published in 2009. 15 A total of 131 injuries were covered by the seven studies.…”

“…The nerve defect length ranged from 5 to 100 mm. Interestingly, only the study of Squintani et al 16 attempted to use their cryopreserved decellularized nerve for a nerve gap longer than 50 mm. Most nerve gaps were due to trauma, followed by neuroma resection and complex mechanisms (e.g., amputation/avulsion, blast, compression/crush, gunshot).…”

“…►Table 2 summarizes the key points of the surgical technique used in the studies. The study of Squintani et al 16 was the only one to apply decellularized nerves for brachial plexus nerve surgery using procedures such as neurotization and nerve transfer. The other studies focused on bridging the discontinued nerve.…”

“…Ducic et al 13 additionally used a nerve connector over both the proximal and distal anastomosis. As for postoperative treatment, Taras et al 16 applied plaster orthosis over a sterile gauze bandage until the first postoperative visit.…”