Case Series of Traumatic Peripheral Nerve Injuries in Pediatric Patients Treated with Allograft Repair

Purpose: In the adult literature, allograft reconstruction of gapped peripheral nerve injuries has gained popularity over autologous nerve grafting. Allografts have demonstrated similar recovery while eliminating donor site morbidity. There is no well-defined incidence or treatment of such injuries in children. Our study explores the epidemiology and outcomes of traumatic pediatric peripheral nerve injuries treated with allograft.

Methods: This is a retrospective case series of a prospectively maintained database of all pediatric patients who underwent nerve allograft reconstruction at a Level I trauma center between September 2011 and July 2021.

Results: We identified 24 allograft nerve reconstructions in 18 patients, average age 12.9 years (range 1.5-17.0) and 78% male. Five patients (28%) were injured in a motor vehicle accident, and four were injured by sharp laceration, machinery, and blast injury (22%). The most injured nerve was digital (n = 10, 42%) followed by 8 (33%) ulnar, and 4 (17%) median. The average gap length was 30.3 ± 23.8 mm (range 4-87 mm). Fifteen nerves were repaired within 24 hours (63%). Average follow-up was 13.7 ± 14.5 months (range 1.6-46.8 months). At final follow-up, 9 (38%) had full sensory recovery, 6 (25%) protective sensation, 2 (8%) deep pressure, and 1 (4%) no sensation but a positive Tinel's sign.

Conclusions: Allograft reconstruction is a viable option for the treatment of traumatic pediatric peripheral nerve injuries with gaps not amenable to direct repair.

Type of study/level of evidence: Therapeutic IV.