Sunday, October 8, 2006
10152

Nerve Allograft Transplantation for Functional Restoration of the Upper Extremity

Andrew I. Elkwood, MD, MBA, Matthew R. Kaufman, MD, Michael I. Rose, MD, W.D. Shi, BS, Jonathan Liu, MD, Neil R. Holland, MD, and Spiro M. Arbes, MD.

Brachial plexus injuries may cause severe sensorimotor disturbances. Functional restoration often is incomplete due to a limited supply of autologous grafts. Utilizing nerve allografts it may be possible to overcome the limitations associated with purely autologous reconstructions.

Seven patients with multi-level brachial plexus injuries were selected for transplantation using cadaveric or living-related allografts. The immunosuppressive protocol was initiated at the time of surgery and discontinued when signs of regeneration were evident. Parameters for assessment included: injury mechanism, interval between injury and treatment, level(s) of deficit, functional return, pain relief, revision surgery, and complications.

There were 6 males and one female with an average age of 23. Surgery was performed using living-related donor grafts in 5 patients, and cadaveric grafts in two patients. Immunosuppression was tolerated in all but one patient in whom early termination occurred due to noncompliance. There were no cases of graft rejection and 6 patients experienced functional recovery.

Nerve allograft transplantation may be performed safely permitting non-prioritized repair of long segment peripheral nerve defects and maximizing the number of axonal conduits per repair. For patients with multi-level brachial plexus injuries, the use of nerve allograft allows a more complete repair that may translate into greater functional restoration.


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