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. 2024 Sep 21;6(6):801-807.
doi: 10.1016/j.jhsg.2024.05.008. eCollection 2024 Nov.

Case Series of Traumatic Peripheral Nerve Injuries in Pediatric Patients Treated with Allograft Repair

Jacqueline Van Gheem  1 , Alexis Rounds  1 , Taylor Blackwood  1 , Cameron Cox  1 , Evan J Hernandez  1 , Desirae McKee  1 , Brendan MacKay  1
Affiliations

Case Series of Traumatic Peripheral Nerve Injuries in Pediatric Patients Treated with Allograft Repair

Jacqueline Van Gheem et al. J Hand Surg Glob Online. .

Abstract

Purpose: In the adult literature, allograft reconstruction of gapped peripheral nerve injuries has gained popularity over autologous nerve grafting. Allografts have demonstrated similar recovery while eliminating donor site morbidity. There is no well-defined incidence or treatment of such injuries in children. Our study explores the epidemiology and outcomes of traumatic pediatric peripheral nerve injuries treated with allograft.

Methods: This is a retrospective case series of a prospectively maintained database of all pediatric patients who underwent nerve allograft reconstruction at a Level I trauma center between September 2011 and July 2021.

Results: We identified 24 allograft nerve reconstructions in 18 patients, average age 12.9 years (range 1.5-17.0) and 78% male. Five patients (28%) were injured in a motor vehicle accident, and four were injured by sharp laceration, machinery, and blast injury (22%). The most injured nerve was digital (n = 10, 42%) followed by 8 (33%) ulnar, and 4 (17%) median. The average gap length was 30.3 ± 23.8 mm (range 4-87 mm). Fifteen nerves were repaired within 24 hours (63%). Average follow-up was 13.7 ± 14.5 months (range 1.6-46.8 months). At final follow-up, 9 (38%) had full sensory recovery, 6 (25%) protective sensation, 2 (8%) deep pressure, and 1 (4%) no sensation but a positive Tinel's sign.

Conclusions: Allograft reconstruction is a viable option for the treatment of traumatic pediatric peripheral nerve injuries with gaps not amenable to direct repair.

Type of study/level of evidence: Therapeutic IV.

Keywords: Allograft; Nerve injury; Nerve trauma pediatric; Peripheral nerve.

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Conflict of interest statement

Dr MacKay is a primary investigator in the “A Multicenter Registry Study of Avance Nerve Graft Utilization, Evaluations and Outcomes in Peripheral Nerve Injury Repair” (RANGER) database, and we are a RANGER data collection site. Drs McKee and Mackay have been consultants for Axogen since 2019 and 2018, respectively. Mr Hernandez has been a consultant for Axogen since 2024. No benefits in any form have been received or will be received by the other authors related directly to this article.

Figures

Figure 1
Figure 1
Distribution of the mechanisms of injuries. Sharp laceration included knife or glass injuries. Machinery included Auger or saw injuries. Blast included gunshot wounds and firework injuries. One neuroma was a result of a glass injury 1 year prior. ATV, all-terrain vehicle; MVC, motor vehicle accident.
Figure 2
Figure 2
Distribution of nerves injured. The percentages of specific nerve injuries that were repaired are reported.
Figure 3
Figure 3
Sensory recovery. The amount of sensation recovered since time of repair is reported. Image to the right demonstrates patients who were too young to undergo Semmes-Weinstein testing (n = refers to number of nerves). SW, Semmes-Weinstein.
Figure 4
Figure 4
Motor recovery in those with mixed sensory and motor nerve injury. ROM, range of motion.
Figure 5
Figure 5
Injury and intraoperative photos. A 3-year-old from a motor vehicle accident with partial arm amputation.
See this image and copyright information in PMC

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