Reconstruction of Critical Nerve Defects Using Allogenic Nerve Tissue: A Review of Current Approaches

Abstract

Regardless of the nerve defect length, nerve injury is a debilitating condition for the affected patient that results in loss of sensory and motor function. These functional impairments can have a profound impact on the patient’s quality of life. Surgical approaches for the treatment of short segment nerve defects are well-established. Autologous nerve transplantation, considered the gold standard, and the use of artificial nerve grafts are safe and successful procedures for short segment nerve defect reconstruction. Long segment nerve defects which extend 3.0 cm or more are more problematic for repair. Methods for reconstruction of long defects are limited. Artificial nerve grafts often fail to regenerate and autologous nerve grafts are limited in length and number. Cadaveric processed/unprocessed nerve allografts are a promising alternative in nerve surgery. This review gives a systematic overview on pre-clinical and clinical approaches in nerve allograft transplantation.

Facial Nerve Reconstruction Using Acellular Nerve Allograft

“…The success of acellular allografts in the case of peripheral nerve reconstruction is well-documented 4–10 . The use of PNAs in the repair of cranial nerve injuries, however, has significantly less data.…”

“…Furthermore, the acellular nature of these cadaveric grafts raises the concern for their ability to regenerate in the cytotoxic therapy such as radiation. In such a context, the efficacy of these grafts remains unclear, and the application of an autografting technique as described above may be more heavily favored 9–10 . Given the numerous potential benefits, further investigation regarding the clinical application of nerve allograft to nonperipheral nerve reconstruction is warranted.…”

“…The success of acellular allografts in the case of peripheral nerve reconstruction is well-documented. [4][5][6][7][8][9][10] The use of PNAs in the repair of cranial nerve injuries, however, has significantly less data. Consequently, there is little documentation regarding their application to facial nerve injuries.…”

“…In such a context, the efficacy of these grafts remains unclear, and the application of an autografting technique as described above may be more heavily favored. [9][10] Given the numerous potential benefits, further investigation regarding the clinical application of nerve allograft to nonperipheral nerve reconstruction is warranted.…”

Implantable Biomaterials for Peripheral Nerve Regeneration–Technology Trends and Translational Tribulations

“…Another product developed by Integra Life Sciences (Plainsboro, NJ) and composed of semi-permeable Type I collagen is marketed under name Neuragen. A practical limitation of tubular collagen products is their tendency to collapse and kink and their potential for scarring ( Kornfeld et al, 2021a ).…”