Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science Univeristy, Portland, OR, USA.
Hand (N Y). 2023 Mar;18(2):236-243. doi: 10.1177/15589447211003175. Epub 2021 Apr 21.
Acellular nerve allografts have been used successfully and with increasing frequency to reconstruct nerve injuries. As their use has been expanded to treat longer gap, larger diameter nerve injuries, some failed cases have been reported. We present the histomorphometry of 5 such cases illustrating these limitations and review the current literature of acellular nerve allografts.
Between 2014 and 2019, 5 patients with iatrogenic nerve injuries to the median or ulnar nerve reconstructed with an AxoGen AVANCE nerve allograft at an outside hospital were treated in our center with allograft excision and alternative reconstruction. These patients had no clinical or electrophysiological evidence of recovery, and allograft specimens at the time of surgery were sent for histomorphological examination.
Three patients with a median and 2 with ulnar nerve injury were included. Histology demonstrated myelinated axons present in all proximal native nerve specimens. In 2 cases, axons failed to regenerate into the allograft and in 3 cases, axonal regeneration diminished or terminated within the allograft.
The reported cases demonstrate the importance of evaluating the length and the function of nerves undergoing acellular nerve allograft repair. In long length, large-diameter nerves, the use of acellular nerve allografts should be carefully considered.
去细胞神经同种异体移植物已成功且越来越频繁地用于重建神经损伤。随着其应用范围扩大到治疗更长间隙、更大直径的神经损伤，一些失败的病例也有报道。我们展示了 5 例此类病例的组织形态计量学结果，说明了这些局限性，并回顾了去细胞神经同种异体移植物的当前文献。
在 2014 年至 2019 年期间，在我院对 5 名在其他医院因医源性损伤导致正中神经或尺神经损伤的患者进行了 AxoGen AVANCE 去细胞神经同种异体移植物重建。这些患者没有临床或电生理恢复的证据，手术时同种异体移植物标本均进行了组织形态学检查。
纳入了 3 例正中神经和 2 例尺神经损伤的患者。组织学显示所有近端原生神经标本中均存在有髓轴突。在 2 例中，轴突未能再生到同种异体移植物中，在 3 例中，轴突再生减少或在同种异体移植物中终止。
报道的病例表明评估接受去细胞神经同种异体移植物修复的神经的长度和功能的重要性。在长距离、大直径神经中，应谨慎考虑使用去细胞神经同种异体移植物。
