Authors: P. David Adelson, MD, FAANS, FACS; Laura Hamant, MD; Paul Kang; Jorge Arango, MD; Danielle Brown; P. David Adelson, MD (Phoenix, AZ)
To determine the functional efficacy of acellular processed nerve allografts as compared to sural nerve autografts harvested at time of surgery.
This is a retrospective case cohort of patients who underwent surgical repair of an obstetrical brachial plexus injury (OBPI) using either a sural nerve autograft or a decellularized processed cadaveric nerve allograft. There were 52 patients total, 22 in the autograft (control) and 30 in the allograft (intervention) groups. The primary outcome measures were motor strength and functionality measured by the British motor strength score and Mallet score, respectively. Secondary outcomes included surgical time, rate of complications, and future surgeries. Outcomes were analyzed and reported pre- and post-surgery.
There was no significant difference in the motor strength and functional outcomes between the sural nerve autografts and allografts in follow-up to the surgery. Mean follow up was 614 days (SD = 547). Functionally, the mean difference (SD) on the observed Mallet score from pre-op to last follow-up of autograft was 0.71 (0.82) to 1.31 (0.94) and 0.78 (0.75) to 1.25 (0.75) for the allograft group. Allografts had shorter operative time (Beta (95% CI): -30.7 minutes (-62.7, 1.31)) but same rate of future surgeries although this association only trended toward significance with a p = 0.06. Two patients had superficial infections with stitch abscesses in the autograft group at the sural nerve harvest site and no infections in the allograft group (9% vs. 0%) (p=0.17). All patients with the autograft had anesthesia in the sural nerve distribution on the dorsum of the foot.
These data would suggest that nerve allografts can be utilized in OBPI repair as they have comparable motor and functional outcomes to autograft but require only one surgical site, had decreased surgical time, and decreased risk of complications.