Nerve allograft transplantation for functional restoration of the upper extremity: case series

In a groundbreaking series published in The Journal of Spinal Cord Medicine, Elkwood et al. introduce nerve allograft transplantation as a novel approach to treating complex brachial plexus injuries. This technique offers a potential solution for patients with extensive nerve defects that exceed the capacity of autologous grafting.

Methodology and Patient Cohort

The study included 8 patients with multi-level brachial plexus injuries. These patients underwent nerve allograft transplantation using either cadaveric or living-related donor nerves. The surgical procedures involved nerve exploration with intraoperative electrophysiological testing and nerve grafting using both autologous and allograft sources.

Key Findings

With a varied follow-up period, the results show promising outcomes:

1. 7 out of 8 patients showed signs of regeneration
2. 4 patients experienced recovery of sensory and motor function
3. 4 patients demonstrated a migrating Tinel's sign
4. Immunosuppression was well-tolerated in all but one patient

Implications for Clinical Practice

This innovative approach offers several advantages:

• Provides an alternative for patients with insufficient autologous nerve graft material
• Allows for more extensive nerve reconstruction in complex cases
• Demonstrates the safety and potential efficacy of nerve allograft with limited immunosuppression

While more extensive studies with longer follow-ups are needed, these initial results suggest that nerve allograft transplantation could significantly improve outcomes for patients with severe brachial plexus injuries.

We encourage you to read the full study for a detailed review of the technique and outcomes.

As we continue to advance our understanding of nerve reconstruction, techniques like nerve allograft transplantation offer new hope for improving function in patients with complex brachial plexus injuries.