Purpose
Biomaterials used to restore digital nerve continuity after injury associated with
a defect may influence ultimate outcomes. An evaluation of matched cohorts undergoing
digital nerve gap reconstruction was conducted to compare processed nerve allograft
(PNA) and conduits. Based on scientific evidence and historical controls, we hypothesized
that outcomes of PNA would be better than for conduit reconstruction.
Methods
We identified matched cohorts based on patient characteristics, medical history, mechanism
of injury, and time to repair for digital nerve injuries with gaps up to 25 mm. Data
were stratified into 2 gap length groups: short gaps of 14 mm or less and long gaps
of 15 to 25 mm. Meaningful sensory recovery was defined as a Medical Research Council
scale of S3 or greater. Comparisons of meaningful recovery were made by repair method
between and across the gap length groups.
Results
Eight institutions contributed matched data sets for 110 subjects with 162 injuries.
Outcomes data were available in 113 PNA and 49 conduit repairs. Meaningful recovery
was reported in 61% of the conduit group, compared with 88% in the PNA group. In the
group with a 14-mm or less gap, conduit and PNA outcomes were 67% and 92% meaningful
recovery, respectively. In the 15- to 25-mm gap length group, conduit and PNA outcomes
were 45% and 85% meaningful recovery, respectively. There were no reported adverse
events in either treatment group.
Conclusions
Outcomes of digital nerve reconstruction in this study using PNA were consistent and
significantly better than those of conduits across all groups. As gap lengths increased,
the proportion of patients in the conduit group with meaningful recovery decreased.
This study supports the use of PNA for nerve gap reconstruction in digital nerve reconstructions
up to 25 mm.
Type of study/level of evidence
Therapeutic III.
Key words
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Article info
Publication history
Published online: September 30, 2020
Accepted:
July 27,
2020
Received:
August 27,
2019
Footnotes
Drs Leversedge and Nydick are consultants for AxoGen. Drs Nydick, Zoldos, MacKay, McKee, Safa, Hoyen, and Buncke are research/clinical advisors for AxoGen. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
