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. 2021 Dec 7;9(12):e3983.
doi: 10.1097/GOX.0000000000003983. eCollection 2021 Dec.

A Retrospective Case Series of Peripheral Mixed Nerve Reconstruction Failures Using Processed Nerve Allografts

Hailey P Huddleston  1 , Joey S Kurtzman  1 , Katherine M Connors  1 , Steven M Koehler  2
Affiliations

A Retrospective Case Series of Peripheral Mixed Nerve Reconstruction Failures Using Processed Nerve Allografts

Hailey P Huddleston et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Favorable rates of meaningful recovery (≥M3/S3) of processed nerve allografts (PNAs) for mixed and motor nerve injuries have been reported, but there are few reports of patients having complete PNA failure (M0/S0). The purpose of this study was to describe the outcomes, including rate of complete failures, in a case series of patients who underwent PNA for peripheral mixed nerve reconstructions.

Methods: A retrospective review of outcomes between May 2018 to September 2020 was performed. Consecutive patients who underwent nerve reconstruction (>15 mm) with PNA for a peripheral mixed nerve injury of the upper or lower extremity were eligible. Those who returned to clinic for a 10-month postoperative visit were included in this study. The primary outcome was whether the patient was defined as having a complete failure (M0/S0).

Results: A total of 22 patients underwent a PNA during the time period; 14 patients participated in follow-up and were included (average age: 34.7 years) with a mean follow-up of 11.9 months. The average gap length was 46.4 mm (range 15-110 mm). At their 10-month postoperative visit, no patients had any motor or sensory improvement; all patients were deemed as having complete failure. Four patients underwent or were planned for subsequent revision surgery.

Conclusions: In this study, we demonstrated a high number of complete failures, with all 14 included patients sustaining a complete failure (100% failure rate) at a minimum 10-month follow-up visit. Failure in this case series was not observed to affect one nerve type, location, or be related to preoperative injury size.

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Conflict of interest statement

Disclosure: Dr. Steven Koehler is a committee member of the American Society for Surgery of the Hand (ASSH), a paid consultant and speaker for Integra LifeSciences, Inc, a paid consultant for Tissium, Inc., a stockholder and member of the medical advisory board for Reactiv, Inc., a member of the advisory board for Androes, LLC, and a speaker for TriMed, Inc. All the other authors declare no financial interest in relation to the content of this article. This study did not receive any grant.

Figures

Fig. 1.
Fig. 1.
Flowchart of included patients.
Fig. 2.
Fig. 2.
Intraoperative photographs from an 18-year-old male patient who developed (A) significant adhesions and (B) an 8 cm neuroma of the median nerve 10 months after undergoing a PNA nerve reconstruction. The patient subsequently underwent a neuroma resection and cabled sural nerve autograft reconstructions. A significant neuroma was observed in both patients who underwent revision surgery after failed PNA.
See this image and copyright information in PMC

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