Comparison of Autografts vs. Allografts in the Surgical Repair of Pediatric Obstetrical Brachial Plexus Injuries

Abstract

Obstetrical Brachial Plexus Injuries(OBPI) occur during delivery with a global incidence ranging from 0.2- 4% of live births, and generally, prognosis is excellent with spontaneous recovery in up to 95% of patients. For patients with OBPI that do not obtain a functional recovery by 4-6 months of life, treatment is primarily surgical in nature. Surgical treatment involves testing of the nerves to determine whether they remain connected distally and proximaly, removal of scar tissue/ neurolysis, and then bridging the nerve discontinuity or block with a nerve graft. Nerve grafting provide a three-dimensional extracellular matrix that promotes Schwann cell migration and axon regeneration. Historically, nerve graft was autograft using sural nerve. More recently, a decellularized processed cadaveric nerve allograft (Axogen) has been utilized in numerous peripheral nerve injury repairs, mostly in adults, but has not been reportedly used in pediatric OBPI. The aim of this study is to determine if using nerve allografts (Axogen) will have similar functional outcomes as compared to sural nerve autografts in reconstruction of the brachial plexus after OBPI.