Abstract
Background Short-gap digital nerve injuries are a common surgical problem, but the optimal treatment
modality is unknown. A multicenter database was queried and analyzed to determine
the outcomes of nerve gap reconstructions between 5 and 15 mm with processed nerve
allograft.
Methods The current RANGER registry is designed to continuously monitor and compile injury,
repair, safety, and outcomes data. Centers followed their own standard of care for
treatment and follow-up. The database was queried for digital nerve injuries with
a gap between 5 and 15 mm reporting sufficient follow-up data to complete outcomes
analysis. Available quantitative outcome measures were reviewed and reported. Meaningful
recovery was defined by the Medical Research Council Classification (MRCC) scale at
S3-S4 for sensory function.
Results Sufficient follow-up data were available for 24 subjects (37 repairs) in the prescribed
gap range. Mean age was 43 years (range, 23–81). Mean gap was 11 ± 3 (5–15) mm. Time
to repair was 13 ± 42 (0–215) days. There were 25 lacerations, 8 avulsion/amputations,
2 gunshots, 1 crush injury, and 1 injury of unknown mechanism. Meaningful recovery,
defined as S3-S4 on the MRCC scales, was reported in 92% of repairs. Sensory recovery
of S3+ or S4 was observed in 84% of repairs. Static 2PD was 7.1 ± 2.9 mm (n = 19). Return to light touch was observed in 23 out of 32 repairs reporting Semmes-Weinstein
monofilament outcomes (SWMF). There were no reported nerve adverse events.
Conclusion Sensory outcomes for processed nerve allografts were equivalent to historical controls
for nerve autograft and exceed those of conduit. Processed nerve allografts provide
an effective solution for short-gap digital nerve reconstructions.
Keywords
processed nerve allograft - digital nerve - nerve reconstruction - peripheral nerve
