The role of processed nerve allograft in peripheral nerve surgery

Abstract

Objective: Peripheral nerve surgery involves the direct repair of peripheral nerves after trauma, reconstruction of nerve gaps and the management of painful nerve conditions such as end neuroma. There are a variety of situations where direct microsurgical repair is not possible or not the preferred option. Processed nerve allograft (PNA) offers a bespoke solution in the management of nerve gaps without the morbidity associated with autografts. Methods: A prospective database was populated for patients having nerve allograft implantation in the management of peripheral nerve injury. Results: Between July 2015 and November 2018 (40 months), 62 nerves in 45 patients were treated with AVANCE® PNA at the Birmingham Hand Centre at the Queen Elizabeth Hospital, Birmingham, UK. The mean age at implantation was 43 (range 16–77). Digital nerve reconstruction formed 50% of the total nerve repairs. Indications were 20 digital neuroma reconstructions, 13 neuromas after amputation, 20 traumatic injuries with nerve tissue loss, 8 delayed presentation after trauma, 3 contraindications to general anaesthesia, 4 insufficient autografts, 1 failed autograft and 3 tumour reconstructions. Conclusion: AVANCE® PNA is a useful tool in the reconstruction of peripheral nerve injury and the management of painful neuromas. An absolute indication is the management of painful neuromas in sensitised patients where avoidance of an additional site of neuropathic pain at a donor site is an important consideration. In digital neuroma management, there is good evidence to support use with equivalent efficacy to autologous sensory nerve grafts of a similar length.