Thanks for your thoughts. I agree with the concept of replant advance allograft to avoid potential sacrifice of autograft in a part that eventually may be amputated. The option to delay the nerve reconstruction until 3 months after digit survival I have always found challenging. Re-exploration of a digit with a vascular reconstruction poses a risk of damage to the vascular repair and delays functional sensory recovery. The challenge is justifying the cost for what may become an amputated digit.
In the gap reconstruction I am reviewing my large allograft cases as I agree with your thoughts on cabled allograft as potentially being a superior option to a large diameter allograft. The evidence for this from the RANER database hasn’t been presented or published to date but it makes sense that the greater surface area: volume ration enhances vascular ingrowth.
Regarding the duration of recovery through the graft, do you have any prospective data on rate of Tinel’s progression in your cases to support your claim. I personally agree that recovery, particularly in motor reconstruction cases seems to take twice as long as a comparable autologous graft. Perhaps we should pool our cases and look at this aspect of allograft recovery?
- This reply was modified 2 weeks, 6 days ago by Dominic Power.