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Buncke. Plast Aesthet Res 2022;9:38 Plastic and
DOI: 10.20517/2347-9264.2022.08
Aesthetic Research

Review Open Access

Peripheral nerve allograft: how innovation has
changed surgical practice

Gregory Buncke

The Buncke Clinic, San Francisco, CA 94114, USA.
Correspondence to: Dr. Gregory Buncke, The Buncke Clinic, 45 Castro Street, San Francisco, CA 94114, USA. E-mail:
gbuncke@buncke.org

How to cite this article: Buncke G. Peripheral nerve allograft: how innovation has changed surgical practice. Plast Aesthet Res
2022;9:38. https://dx.doi.org/10.20517/2347-9264.2022.08
Received: 2 Feb 2022 First Decision: 11 Apr 2022 Revised: 25 Apr 2022 Accepted: 6 May 2022 Published: 20 May 2022

Academic Editors: Harvey Chim, Matthew L. Iorio Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

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

Keywords: Peripheral nerve repair, nerve autograft, nerve allograft, nerve conduit

© The Author(s) 2022. 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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