1 Recommendations

Guidance

1.1 Current evidence on the safety and efficacy of processed nerve allografts to repair peripheral nerve discontinuities is adequate to support the use of this procedure for digital nerves provided that standard arrangements are in place for clinical governance, consent and audit.

1.2 The evidence on the safety of processed nerve allografts to repair peripheral nerve discontinuities in other sites raises no major safety concerns. However, current evidence on its efficacy in these sites is limited in quantity. Therefore, for indications other than digital nerve repair, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

1.3 Clinicians wishing to do processed nerve allografts to repair peripheral nerve discontinuities in sites other than the digital nerves should:

Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's efficacy on mixed nerve repair and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having processed nerve allografts to repair peripheral nerve discontinuities (see section 7.1).

1.4 This procedure should only be done by surgeons with training and experience in peripheral nerve repair.

1.5 Patient selection should take into consideration the site, type of nerve (motor, sensory, mixed) and the size of the defect.

1.6 NICE encourages further research into processed nerve allografts to repair peripheral nerve discontinuities. This should include information on the type of nerve repaired, the anatomical site, the size of the defect, patient reported outcome measures, functional outcomes, time to recovery and long-term outcomes (12 months to 18 months).