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Buncke. Plast Aesthet Res 2022;9:38 https://dx.doi.org/10.20517/2347-9264.2022.08 Page 13 of 17

neurotrophic growth factor, fibroblast growth factor, glial growth factor, ciliary neurotrophic factor,
[89]
vascular endothelial growth factor, and brain-derived growth factor) components . These additives to
[89]
luminal fillers have shown beneficial nerve regeneration effects across a nerve gap .
Engineered nerve allografts have also been evaluated with the use of additives and cellular enhancements,
which showed that enhancement with additives or cells improve regenerative potential. However, these
[91]
[90]
results are only available in the pre-clinical phase of research, as to date there is no FDA cleared
commercially available biological additives or cells for the clinical application to engineered nerve conduits
[48]
or allografts . The ability to use this technology clinically will require additional research and clearance by
appropriate regulatory bodies. When available, the clinical use of new conduit materials, luminal fillers,
additives or cells will likely continue to expand the surgical algorithm in the future.

CONCLUSION
In conclusion, engineered nerve allografts have impacted the peripheral nerve repair surgical paradigm and
should be considered as an alternative to nerve autograft for peripheral nerve repair. The use of engineered
nerve allografts, such as Avance nerve graft, show meaningful motor and sensory recovery in nerve gaps up
to 70 mm in length. Recent data has provided confidence for the use of clinically available engineered nerve
grafts even for repair of longer nerve gaps 50-70 mm in length. Furthermore, the use of engineered nerve
allograft as an alternative to autograft circumvents nerve autograft comorbidities, such as sensory deficits
and chronic pain. While the surgical algorithm for peripheral nerve repair is ever-changing, additional
research and clearance for clinical use by regulatory bodies are required to advance current surgical
techniques.

DECLARATIONS
Acknowledgments
The author would like to acknowledge the support of Dr. Anne Engemann and her team for review of this
manuscript prior to submission.

Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author is a paid consultant for Axogen; however, no financial support was provided for the creation of
this manuscript.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.