Peripheral nerve allograft: how innovation has changed surgical practice

The landscape of available technology and surgical technique has changed over the last several decades, thus leading to changes in peripheral nerve repair algorithm. Neurorrhaphy is a common procedure; however, it well recognized that should be performed tensionless, preventing ability perform direct with gap. Historically, gaps were repaired autograft. However, autograft surgery been associated complications such as numbness chronic pain, which left surgeons searching for alternatives. Nerve allografts first utilized 1800s but failed due immune response. In modern era, they again 1980s, did not gain popularity because need use immunosuppressants. It was evident through 1990s continued innovation needed, studies showed only approximately 50% patients gap achieved good or excellent outcomes. 2000s, advent an engineered allograft (Avance® Graft) repair. Early clinical evaluation Avance adequate sensation able up 30 mm, providing alternative autografts. As became more conventional, 87.3% meaningful recovery 50 mm. Furthermore, recent have shown between 50-70 mm 69% recovery. While continue improve, these results are promising large