Nerve Reconstruction Using Processed Nerve Allograft in the U.S. Military

Area of Science:

• Neurosurgery
• Regenerative Medicine
• Military Medicine

Background:

• Processed nerve allograft (PNA) is explored as an alternative to autograft for peripheral nerve reconstruction.
• Military populations often sustain complex nerve injuries due to blast mechanisms and large injury zones.
• This study investigates PNA efficacy in active duty service members.

Purpose of the Study:

• To evaluate the rate of meaningful motor recovery (MRC grade ≥3) following peripheral nerve repair with PNA in a military cohort.
• To identify factors influencing recovery, such as injury type and defect size.
• To compare PNA outcomes against hypothesized autograft results in complex military nerve injuries.

Main Methods:

• Retrospective review of the military Registry of Avance Nerve Graft Evaluating Utilization and Outcomes for the Reconstruction of Peripheral Nerve Discontinuities database.
• Inclusion of adult active duty military patients undergoing PNA for complete nerve injuries.
• Assessment of motor and sensory function using British Medical Research Council standards by a multidisciplinary team.

Main Results:

• Twenty-five nerve injuries in 23 service members were reconstructed with PNA, with a mean age of 30.
• The sciatic nerve was most commonly affected (28%) by complex mechanisms, with an average defect of 77 mm.
• A meaningful motor recovery rate of 24% was observed, with longer follow-up correlating positively with improved motor function (r=0.49, P=.03).

Conclusions:

• Military personnel present with complex nerve injuries and large gaps, posing treatment challenges.
• The observed low rate of meaningful recovery (27.3%) with PNA highlights the difficulty in treating these injuries.
• Further research is warranted to ascertain if autografting yields superior results in similar military populations.