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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