Electrodiagnostic Grade and Carpal Tunnel Release Outcomes: A Prospective Analysis

PURPOSE

The value of electrodiagnostic (EDX) study grades as a prognostic indicator of clinical results after carpal tunnel release (CTR) remains controversial. In this study, we tested the primary null hypothesis that symptom relief after CTR would not differ based on EDX grade. Secondarily, we evaluated the degree of symptomatic and functional postoperative improvement relative to preoperative EDX grade.

METHODS

We prospectively evaluated 199 consecutive patients with 256 hands after CTR confirmed with EDX. Data were collected before surgery and patients were observed at 2 weeks and 3 months after surgery. There were 20 hands with mild, 126 with moderate, and 110 with severe involvement in the preoperative EDX. Demographic, EDX grade (mild, moderate, or severe); surgical parameters; Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; symptom severity scale, functional status scale, pain catastrophizing scale, and visual analog scale data were collected and analyzed.

RESULTS

There was significant improvement in Quick-Disabilities of the Arm, Shoulder, and Hand, symptom severity scale, and functional status scale scores from the preoperative to 2-week and 3-month postoperative visits in all categories of EDX grade. There was no significant difference in the extent of recovery by the 2-week and 3-month visits relative to EDX grade. Catastrophic thinking did not have a significant effect on any of the 3 groups. Pain decreased dramatically at 2 weeks after surgery but there was no additional significant difference in visual analog scale scores between the 2-week and 3-month postoperative visits. Postoperative pain improvement occurred regardless of EDX grade. There were no major complications or reoperations in any group.

CONCLUSIONS

Carpal tunnel release demonstrated consistently significant improvement in outcomes regardless of EDX grade at initial and final follow-up. The extent of postoperative improvement after CTR overall was also not statistically different between groups with differing EDX severity. Older patients with severe CTS achieved more modest gains.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Topiramate-induced Neuropathy Mimicking Carpal Tunnel Syndrome: A Case Report

Carpel tunnel syndrome (CTS) is a condition in which median nerve compression results in paresthesias and pain in the wrist and hand. We are going to report a rare case of topiramate-induced neuropathy which clinically resembles CTS. Discontinuation of topiramate resulted in spontaneous resolution of numbness, paresthesia and pain in a few days. High clinical suspicion is advised in patients who are on topiramate and present with signs of compressive neuropathy. Level of evidence: V.

Patterns of production of collagen-rich deposits in peripheral nerves in response to injury: A pilot study in a rabbit model

INTRODUCTION

Although collagen-rich deposits are the main component of neural scars, the patterns of their formation are ill defined. Essential to the biosynthesis of collagen fibrils are enzymes catalyzing posttranslational modifications and chaperones that control the formation of the collagen triple helix. Prolyl-4-hydroxylase (P4H) and heat shock protein-47 (HSP47) play a key role, and their production is upregulated during scar formation in human tissues. Alpha smooth muscle actin (αSMA) is also produced during fibrotic processes in myofibroblasts that participate in fibrotic response. In injured peripheral nerves, however, the distribution of cells that produce these markers is poorly understood.

METHODS

The goal of this study was to determine the distribution of the αSMA-positive, HSP47-positive, and the P4H-positive cells to better understand the formation of collagen-rich fibrotic tissue (FT) in response to peripheral nerve injury. To reach this goal, we employed a rabbit model of crush-injury and partial-transection injury of the sciatic nerves.

RESULTS

Our study demonstrated that αSMA is expressed in a relatively small number of cells seen in neural FT. In contrast, cells producing P4H and HSP47 are ubiquitously present in sites of injury of the sciatic nerves.

CONCLUSION

We contemplate that these proteins may serve as valuable markers that define fibrotic activities in the injured peripheral nerves.

Open Carpal Tunnel Release Outcomes: Performed Wide Awake versus with Sedation

Background  Carpal tunnel release (CTR) is the most common surgery of the hand, and interest is growing in performing it under local anesthesia without tourniquet. To better understand differences, we hypothesized that patients undergoing CTR under wide-awake local anesthesia with no tourniquet (WALANT) versus sedation (monitored anesthesia care [MAC]) would not result in a difference in outcome. Methods  Consecutive cases of electrodiagnostically confirmed open CTR across multiple surgeons at a single center were prospectively enrolled. Data included demographic data, visual analog scale, Levine-Katz carpal tunnel syndrome scale, QuickDASH questionnaire, customized Likert questionnaire, and complications. Results  There were 81 patients enrolled in the WALANT group and 149 patients in the MAC group. There were no reoperations in either group or any epinephrine-related complications in the WALANT group. Disability and symptom scores did not differ significantly between WALANT and sedation groups at 2 weeks or 3 months. Average postoperative QuickDASH, Levine-Katz, and VAS pain scales were the same in both groups. Both groups of patients reported high levels of satisfaction at 91 versus 96% for the WALANT versus MAC groups, respectively ( p  > 0.05). Patients in each group were likely to request similar anesthesia if they were to undergo surgery again. Conclusion  Patients undergoing open CTR experienced similar levels of satisfaction and outcomes with either the WALANT or MAC techniques. There was no statistically significant difference between either group relative to the tested outcome measures. These data should facilitate surgeons and patients' choosing freely between WALANT and MAC techniques relative to complications and outcomes.

Blocking collagen fibril formation in injured knees reduces flexion contracture in a rabbit model

Post-traumatic joint contracture is a frequent orthopaedic complication that limits the movement of injured joints, thereby severely impairing affected patients. Non-surgical and surgical treatments for joint contracture often fail to improve the range of motion. In this study, we tested a hypothesis that limiting the formation of collagen-rich tissue in the capsules of injured joints would reduce the consequences of the fibrotic response and improve joint mobility. We targeted the formation of collagen fibrils, the main component of fibrotic deposits formed within the tissues of injured joints, by employing a relevant rabbit model to test the utility of a custom-engineered antibody. The antibody was delivered directly to the cavities of injured knees in order to block the formation of collagen fibrils produced in response to injury. In comparison to the non-treated control, mechanical tests of the antibody-treated knees demonstrated a significant reduction of flexion contracture. Detailed microscopic and biochemical studies verified that this reduction resulted from the antibody-mediated blocking of the assembly of collagen fibrils. These findings indicate that extracellular processes associated with excessive formation of fibrotic tissue represent a valid target for limiting post-traumatic joint stiffness. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1038-1046, 2017.

The Relationship Between the Intercrease Line and the A1 Digital Pulley: A Cadaveric Study

BACKGROUND

Accurate identification of surface anatomy is critical to identify the location of the A1 pulley. The intercrease line (ICL) describes a transverse line between the radial edge of the proximal palmar crease and the ulnar edge of the distal palmar crease. We hypothesize that this easily identifiable surface landmark approximates the location of the A1 pulley.

METHODS

The ICL was marked on 7 cadaver hands. We marked a point proximal to the proximal digital crease (PDC) equal to the distance between each digit's proximal interphalangeal crease (PIC) and PDC (the PIC/PDC point). We calculated the distance between PIC/PDC points and proximal edge of the A1 pulleys.

RESULTS

The ICL was proximal to A1 in all digits. The PIC/PDC point was distal to A1 in the ring finger, and proximal to A1 in the index, middle, and small fingers. The PIC/PDC point was closer to the A1 pulley than the ICL in the middle and ring fingers.

CONCLUSIONS

Despite less accuracy than the PIC/PDC point at approximating the location of the A1 pulley, the ICL is reliably proximal to the A1 pulley.

Ulnar-Sided Wrist Pain due to Long Ulnar Styloid: A Case Report

Ulnar styloid impaction syndrome involves repetitive friction between an excessively long ulnar styloid and the carpus, resulting in chondromalacia, synovitis, and pain. The arthroscopic diagnosis, evaluation, and management of this syndrome are not well characterized. We present a patient with chronic wrist pain of unknown origin, culminating with arthroscopic findings demonstrating substantial loss of articular cartilage on both the lunate and triquetrum. The patient successfully underwent operative ulnar styloid excision, ultimately resolving chronic wrist pain symptomology.

Ossified Dorsal Wrist Ganglion Cyst: A Case Report

Ganglion cysts are the most common wrist tumors, and 60 -70% originate dorsally from the scapholunate interval. Ossification of these lesions is exceedingly rare, with only one such lesion located in the finger reported in the literature. We present a case of an ossified dorsal wrist ganglion in a 68-year-old woman.

Reliability of the Soong Classification for Volar Plate Position

PURPOSE

The purpose of the present study was to assess the inter- and intraobserver reliability of the Soong classification system for volar plate position. Our hypothesis was that the Soong grade would be found to be reliable.

METHODS

Four physicians (K.F.L., M.R., J.L.M., P.K.B.) were asked to classify lateral wrist radiographs of volar plated distal radius fractures based on the Soong classification on 3 separate occasions. Forty-six distal radius fractures fixed by volar plates were selected from a surgical image database at our institution. Radiographs were selected to ensure that each Soong grade was adequately represented. The physician observers in the current study were blinded to the previously assigned grade and to clinical information regarding the patient.

RESULTS

Based upon the average grade of all 4 observers, 17 plates were Soong grade 0, 20 plates were Soong grade 1, and 9 plates were Soong grade 2. The intraobserver reliability among the 4 observers was 0.94 (95% confidence interval [CI], 0.96-0.89), 0.93 (95% CI, 0.96-0.90), 0. 91 (95% CI, 0.94-0.86), and 0.80 (95% CI, 0.87-0.71). The interobserver reliability was 0.78 (95% CI, 0.85-0.69).

CONCLUSIONS

We found the Soong classification to be a reliable tool in assessing the degree of plate prominence. We continue to use the Soong classification system in describing volar plate position.

CLINICAL RELEVANCE

The use of the Soong classification for determining volar plate prominence is reliable.

A Comparison of Two Sterile Solution Application Methods During Surgical Preparation of the Hand

PURPOSE

The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls.

METHODS

Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software.

RESULTS

There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant.

CONCLUSIONS

We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS.

CLINICAL RELEVANCE

The clinical implications of these findings are unknown.

Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study

Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient's functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach.

Auxiliary proteins that facilitate formation of collagen-rich deposits in the posterior knee capsule in a rabbit-based joint contracture model

Post-traumatic joint contracture is a debilitating consequence of trauma or surgical procedures. It is associated with fibrosis that develops regardless of the nature of initial trauma and results from complex biological processes associated with inflammation and cell activation. These processes accelerate production of structural elements of the extracellular matrix, particularly collagen fibrils. Although the increased production of collagenous proteins has been demonstrated in tissues of contracted joints, researchers have not yet determined the complex protein machinery needed for the biosynthesis of collagen molecules and for their assembly into fibrils. Consequently, the purpose of our study was to investigate key enzymes and protein chaperones needed to produce collagen-rich deposits. Using a rabbit model of joint contracture, our biochemical and histological assays indicated changes in the expression patterns of heat shock protein 47 and the α-subunit of prolyl 4-hydroxylase, key proteins in processing nascent collagen chains. Moreover, our study shows that the abnormal organization of collagen fibrils in the posterior capsules of injured knees, rather than excessive formation of fibril-stabilizing cross-links, may be a key reason for observed changes in the mechanical characteristics of injured joints. This result sheds new light on pathomechanisms of joint contraction, and identifies potentially attractive anti-fibrotic targets.

Measurement of the radiographic anatomy of the small and ring metacarpals using computerized tomographic scans

BACKGROUND

To date, only plain radiographic definitions of normal anatomical parameters have been described. Our study aims to describe normal anatomic measurements of small and ring metacarpals using a novel digital reconstruction technique based on raw CT image data. We hypothesize that current plain radiographic data incorrectly describes normal metacarpal anatomy in the lateral plane.

METHODS

Thirty-five scans of the small and 30 scans of the ring metacarpals form the basis for this study. Using a custom digital 3D image reformatting software, CT sections were reconstructed in the plane of each studied metacarpal. The 3D images were converted to sagittal and coronal weighted projections to represent lateral and posteroanterior (PA) 2D images that are equivalent to "perfect orthogonal" radiographs. Using a customized image measurement program, shaft lengths, shaft-bending angle (SBA), and capital-axis angle (CAA) were measured.

RESULTS

Our results show that CAA averaged 14 and 12° in the ring and small metacarpals, respectively. Apex dorsal SBA averaged 12 and 10° in the ring and small metacarpals, respectively. On the PA images, the shafts are nearly straight. In contrast to prior reported values, we found the CAA to be less acute and the metacarpal curvature less pronounced on the lateral projection. We also demonstrated that much of the metacarpal apex dorsal bend is in the shaft itself.

CONCLUSION

Normal anatomic parameters of metacarpals are based primarily on radiographic data, and as such are limited due to bony overlap in the lateral plane, as well as imperfect radiographic projections that are known to distort anatomical relationships. This novel method of image reconstruction eliminates metacarpal overlap and defines precise anatomical reference for metacarpals.

Intraoperative Physical Examination for Diagnosis of Interosseous Ligament Rupture-Cadaveric Study

PURPOSE

To study the intraobserver and interobserver reliability of the diagnosis of interosseous ligament (IOL) rupture in a cadaver model.

METHODS

On 12 fresh frozen cadavers, radial heads were cut using an identical incision and osteotomy. After randomization, the soft tissues of the limbs were divided into 4 groups: both IOL and triangular fibrocartilage (TFCC) intact; IOL disruption but TFCC intact; both IOL and TFCC divided; and IOL intact but TFCC divided. All incisions had identical suturing. After standard instruction and demonstration of radius pull-push and radius lateral pull tests, 10 physician evaluators with different levels of experience examined the cadaver limbs in a standardized way (elbow at 90° with the forearm held in both supination and pronation) and were asked to classify them into one of the 4 groups. Next, the same examiners were asked to re-examine the limbs after randomly changing the order of examination.

RESULTS

The interobserver reliability of agreement for the diagnosis of IOL injury (groups 2 and 3) was fair in both rounds of examination and the intraobserver reliability was moderate. The intra- and interobserver reliabilities of agreement for the 4 groups of injuries among the examiners were fair in both rounds of examination. The sensitivity, specificity, accuracy, positive, and negative predictive values were all around 70%. The likelihood of a positive test corresponding with the presence of IOL rupture (positive likelihood ratio) was 2.2. The likelihood of a negative test correctly diagnosing an intact IOL was 0.40.

CONCLUSIONS

In cadavers, intraoperative tests had fair reliability and 70% accuracy for the diagnosis of IOL rupture using the push-pull and lateral pull maneuvers. The level of experience did not have any effect on the correct diagnosis of intact versus disrupted IOL.

CLINICAL RELEVANCE

Although not common, some failure of surgeries for traumatic elbow fracture-dislocations is because of failure in timely diagnosis of IOL disruption.

Fingertip Amputation Treatment: A Survey Study

Distal fingertip amputations are common injuries in work- and non-work-related accidents. There is a paucity of evidence to support use of any one treatment. We conducted a study to better understand how surgeon and patient factors influence the treatment preferences for distal fingertip amputations among a cross section of US and international hand surgeons. We sent a 16-question survey to the American Association for Hand Surgery and reciprocal international hand societies and analyzed the response data using a logistic regression model. We hypothesized that hand surgeons' treatment preferences would be varied and influenced by surgeon and patient demographics. One hundred ninety-eight hand surgeons (62% US, 38% international) responded to the survey. For each clinical scenario (Allen levels 2, 3, and 4 and volar oblique amputations), there were wide variations in treatment preferences. Wound care was less likely performed by surgeons with more than 30 years of experience or plastic surgery backgrounds. Replantation was less likely performed by US surgeons and private practice surgeons. Pedicle and homodigital flaps were more commonly performed internationally. Surgeons in practice for less than 5 years were more likely to perform skeletal shortening. For all levels and orientations of fingertip amputation queried, there is a wide range of treatment preferences. Our survey results highlight the need for a prospective randomized trial to elucidate the most effective treatments for fingertip amputations.

Current rates of publication for podium and poster presentations at the american society for surgery of the hand annual meetings

BACKGROUND

Research projects are presented at the Annual Meetings of the American Society for Surgery of the Hand (ASSH). It is unknown how many achieve publication in peer-reviewed journals. We sought to determine current rates of publication of podium and poster presentations.

METHODS

All ASSH podium and poster presentations from 2000 to 2005 were reviewed, and an Internet-based search using PubMed and Google was conducted to determine whether the presented studies had been published. Times to publication and journal names were recorded. Data were analyzed with descriptive statistics. Fisher's exact test was conducted to compare current trends with previous trends.

RESULTS

Of 1127 podium and poster presentations reviewed, 46% were published in peer-reviewed journals. Forty-seven percent of published presentations (242 presentations) were in Journal of Hand Surgery, and 11% (59 presentations) were in Journal of Bone and Joint Surgery. Forty-five percent of presentations were published within 2 years and 66% within 3 years. The publication rate for podium presentations was significantly higher than that previously reported for Journal of Hand Surgery, at 54% compared with 44% (P=0.004).

CONCLUSIONS

Currently, fewer than half of the studies presented at Annual Meetings of the ASSH achieve publication in peer-reviewed journals. Presentations are most likely to be published within 3 years, and almost half are published in Journal of Hand Surgery.

Distal interphalangeal joint bony dimensions related to headless compression screw sizes

PURPOSE

To determine the radiographic dimensions of the distal interphalangeal (DIP) joint and to compare these measurements with commonly used headless compression screws.

METHODS

Using standard posteroanterior and lateral radiographs of the hand, we measured the dimensions of the distal and middle phalanges in 60 index, middle, ring, and little fingers. We then compared these measurements with the diameters and lengths of 16 commercially available headless compression screws commonly used to perform DIP joint arthrodesis. Percent compatibility and risk factors for incompatibility were determined.

RESULTS

In general, commercially available screw diameters were too large given the anatomic dimensions of the DIP joint. The distal phalanx shaft as measured on the lateral view was the narrowest determinant of fit. When the dimensions of all fixation devices were combined, screws were oversized relative to the bony anatomy in 66% of index fingers, 53% of middle fingers, 49% of ring fingers, and 72% of little fingers. This mismatch was greater in women than in men. Only 1 of the compression screw types demonstrated a compatibility rate greater than 90% for the index and little fingers, respectively. A multivariate analysis of independent risk factors showed the likelihood of a compatible fit to vary directly with patient height and to be less likely in the little and index fingers. Interobserver reliability analysis revealed excellent x-ray measurement correlation between observers.

CONCLUSIONS

A size mismatch existed between the anatomic dimensions of the DIP joint and commercially available headless compression screws. Caution must be used when considering these screws for DIP joint arthrodesis, to avoid problems related to screw prominence in the narrow aspects of the distal and middle phalanges.

CLINICAL RELEVANCE

Headless compression screws are frequently oversized for use in DIP arthrodesis.

Frostbite in an adolescent football player: a case report

OBJECTIVE

To present the case of vascular compromise of a finger from a confluent circumferential blister due to an inappropriately applied commercial cold pack in a high school athlete and to describe the mechanism of iatrogenic injury, acute surgical management, rehabilitation, and pathophysiology of frostbite and constriction injuries.

BACKGROUND

A 17-year-old male football player presented with a frostbite and constriction injury to the index finger secondary to prolonged use of a cooling pack after a mild traumatic injury to the digit. He developed a prolonged sensory deficit from thermal injury, as well as acute vascular compromise requiring urgent operative intervention.

DIFFERENTIAL DIAGNOSIS

Frostbite and constriction injury to the index finger.

TREATMENT

Emergency surgical decompression and occupational therapy.

UNIQUENESS

Frostbite injuries can occur iatrogenically because of inappropriate use of cooling devices or gel packs. Fingers are commonly injured extremities that are particularly susceptible to frostbite and compression injuries. To our knowledge, no case of vascular compromise from the blister constriction of digits has been reported.

CONCLUSIONS

Patients and their caregivers must be educated about how to properly use cooling devices. Clinicians need to fully evaluate patients with iatrogenic frostbite injuries, giving particular attention to neurovascular status, and must recognize the need for surgical release of constriction syndrome to prevent substantial morbidity.

Internal fixation of distal metacarpal fractures: new uses for an old plate

Certain metacarpal fracture patterns require operative fixation to restore anatomy and optimize results. Compared with dorsal plating, the width of the minicondylar blade plate buttresses the deforming volar pull of the intrinsics and provides a stronger construct. The implant provides firm fixation in the juxta-articular fragment with minimal space requirements. Therefore, the purpose of this study was to examine the outcomes following the use of a minicondylar blade plate for the treatment of distal metacarpal fractures. Twenty-two distal metacarpal fractures in 20 patients treated with a minicondylar blade plate were retrospectively reviewed. Outcome measures collected included postoperative grip strength, range of motion, return to work, and radiographic evidence of osseous union. Average range of motion of the metacarpophalangeal joint was 62° postoperatively. Eighty-two percent (18/22) of fractures were able to flex their digits to their distal palmar crease. Seventy-one percent (12/17) of patients had at least 75% return to grip strength compared with the contralateral side. Seventeen patients returned to full activity at a mean of 2.5 months (range, 1-3 months) postoperatively; 1 patient was on disability, and data were not available for the final 2 patients. No major complications occurred. The minicondylar blade plate is a safe and effective technique for stabilizing unstable periarticular metacarpal fractures. Stable fixation allows for early range of motion, rapid return to strength, and a relatively quick return to full work duty.

Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective

PURPOSE

In 1987, Duncan et al.(1) reported on a survey of the members of the American Society for the Surgery of the Hand (ASSH) about their practices in treating carpal tunnel syndrome (CTS). To better understand changes in the treatment of CTS over the past 25 years, we repeated the survey while incorporating present-day controversies.

METHODS

With the approval of the ASSH, an Internet-based survey was e-mailed to all members of the Society. This included 33 primary questions focusing on 4 areas of study: surgeon demographic information, nonoperative treatment, surgical technique, and postoperative care. A total of 1,463 surveys were delivered and 707 surveys were completed and returned, for a response rate of 48%. Responses were compared with the responses from Duncan et al. published 25 years ago.(1)

RESULTS

In contrast to the practice patterns identified 25 years ago, this survey identified several changes in current clinical practices including the following statistically significant findings: Preoperatively, surgeons have increased the use of splints and corticosteroid injections, treat nonoperatively longer, and have narrowed their surgical indications. Regarding surgical technique, surgeons now are using tourniquets less, infiltrate the carpal tunnel with corticosteroids less, and place deep sutures less often. Furthermore, performing concomitant procedures along with release of the transverse carpal ligament has decreased. Orthotic use and duration postoperatively also decreased.

CONCLUSIONS

Although significant differences are evident between management of CTS between 1987 and 2011, no consensus has emerged.

The role of nerve allografts and conduits for nerve injuries

Nerve repair after transection has variable and unpredictable outcomes. In addition to advancements in microvascular surgical techniques, nerve allografts and conduits are available options in peripheral nerve reconstruction. When tensionless nerve repair is not feasible, or in chronic injuries, autografts have been traditionally used. As substitute to autografts, decellularized allografts and conduits have become available. These conduits can reduce donor site morbidity, functional loss at the donor area in cases where autografts are used, and immune reaction from transplants or unprocessed allografts. The development of new biomaterials for use in conduits, as well as use of cytokines, growth factors, and other luminal fillers, may help in the treatment of acute and chronic nerve injuries. The indications and properties of nerve conduits and allografts are detailed in this article.