Reconstruction of Peripheral Nerves after Neuroma, and Tumor Resection with Processed Allogenic Nerve Graft (AVANCE® Nerve Graft)

Abstract

Introduction: Autologous nerve grafts are accompanied by morbidity of the donor site, leading to loss of sensation and possible complications such as end neuroma formation or persistent pain. Moreover, the indications are narrow mostly limited to defects in larger motor nerves with good prognosis. One alternative to autografts might be the commercially available allograft (Avance® Nerve Graft). The aim of this study was to assess the safety and outcome of the Avance® Nerve Graft for the reconstruction of peripheral nerves after neuromas, and tumor resection. Materials and Methods: For this purpose, ten patients with eleven implanted grafts were recruited for the prospective study. Five patients suffered from a neuroma-in-continuity, four from an terminal neuroma formation and two from Schwannomas. Seven patients were symptomatic for pain. After the resection, the peripheral nerves were reconstructed with the Avance® Nerve Graft. The patients were followed up for at least six months, by assessing recovery of motor, and sensibility and pain reduction. Results: A significant decrease in pain levels was observed after reconstruction. All patients achieved or remained a meaningful sensory function with levels of S3 or above. Regarding motor function, 85.7% (6 of 7 patients) demonstrated M3 or higher. One patient received a revisional reconstruction upon recurrent neuroma formation. In summary, all patients demonstrated signs of recovery and improvement of their paint situation. Nevertheless, one patient missed a meaningful motor recovery and a second one underwent an additional intervention. Conclusion: The reconstruction with Avance® Nerve Graft demonstrated good outcomes for motor, and sensory function, by achieving a pain reduction in all patients. Of particular interest, was the reconstruction of lesioned purely sensible nerves, for those currently no reasonable reconstruction option exists. Declaration of potential conflicts of interest The financial resources for the conduct of the RANGER study at the Medical University of Vienna are provided by Axogen Inc.