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Chi et al. Plast Aesthet Res 2023;10:70 Plastic and
DOI: 10.20517/2347-9264.2023.89
Aesthetic Research

Commentary Open Access

Limited recovery following acellular nerve allograft
reconstruction in major peripheral nerve injuries

David Chi , Anna Rose Johnson, Susan E. Mackinnon

Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis,
MO 63110, USA.
Correspondence to: Prof. Susan E. Mackinnon, Division of Plastic and Reconstructive Surgery, Washington University School of
Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, MO 63110, USA. E-mail: mackinnons@wustl.edu
How to cite this article: Chi D, Johnson AR, Mackinnon SE. Limited recovery following acellular nerve allograft reconstruction in
major peripheral nerve injuries. Plast Aesthet Res 2023;10:70. https://dx.doi.org/10.20517/2347-9264.2023.89
Received: 25 Sep 2023 First Decision: 8 Nov 2023 Revised: 27 Nov 2023 Accepted: 11 Dec 2023 Published: 28 Dec 2023

Academic Editor: Samuel O. Poore Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Recent studies suggest that acellular nerve allografts (ANA) have similar efficacy as nerve autografts in certain
applications of nerve surgery. However, multiple studies also demonstrate the limitations of nerve allografts,
resulting in poor patient outcomes. This submission discusses a recent case series of patients who failed allograft
use with subsequent histologic analyses of these allografts. Recommendations on the treatment of nerve gaps are
presented, drawing from our current understanding of allograft and autograft utility in reconstruction. Factors taken
into account include recipient critical nerve function, existent nerve gap, and nerve diameter.

Keywords: Nerve reconstruction, peripheral nerve, acellular nerve allograft, nerve autograft

The increasing use of acellular nerve allografts, nerve conduits, and nerve wraps in nerve reconstruction
provides a potential new alternative to nerve repair and nerve autograft. Recent studies, most supported by
industry, suggest that outcomes may be comparable between autografts and acellular nerve allografts
(ANA) . However, a large study from Switzerland showed that ANA reconstruction resulted in poorer
[1,2]
outcomes when used to reconstruct longer length motor nerve injuries. Specific details regarding individual
use cases are often uncaptured in large cohorts, and more nuance is required to accurately interpret and
implement these findings into clinical practice.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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