BACKGROUND: AlloDerm^® is an acellular dermis product that is has been used in burn surgery, soft tissue augmentation and periodontal surgery. In the repair of traumatic nerve injuries, a good surgical outcome is dependent upon both an accurate re-approximation of the nerve endings and an environment that promotes local healing without disruption from surrounding shear forces, local inflammation or invading scar tissue. If these factors are not accounted for and controlled, neuromas at the repair site or inhibited regeneration of the repaired nerve may occur. Unfortunately, painful neuromas and failed repair can lead to significant long-term functional impairment. An AlloDerm sleeve around the repair site may improve surgical repair outcomes by providing a protected environment in which a repaired nerve can effectively regenerate.

CASE REPORTS: A 24 year-old male sustained a complete median nerve transection with development of a neuroma incontinuity just proximal to the wrist crease in the palm of the hand and a 46 year-old male sustained a complete ulnar nerve laceration in the mid-forearm. Following epineural neurorrhaphy of two complete peripheral nerve lacerations, both of the repair sites were wrapped with an AlloDerm sleeve (see Image). Both of the patients did well post-operatively and had expected return of muscle strength and sensation at six and 12 months post-operatively. At long-term follow-up, neither patient developed a problem with compression at the nerve repair site or any indications of a neuroma formation.

CONCLUSION: An AlloDerm nerve sleeve holds promise in preventing neuroma formation and promoting regeneration in peripheral nerve repairs.