Chapter 1
Chapter 1
The use of fresh nerve allograft can potentially allow functional recovery equivalent to autograft; however, it requires systemic immunosuppression. Tacrolimus, Prograf, inhibits activation of T-cell proliferation and is administered starting three days preoperatively and continued for eighteen months postoperatively. Grafts are selected from ABO blood type-compatible individuals, cadaveric or living related donors, and stored at four degrees Celsius in University of Wisconsin solution for seven days before implantation. Rejection and increased vulnerability to opportunistic infection are potential complications. Acellularized nerve allografts are now available with the advantage of decreased host rejection and no need for systemic immunosuppression. These grafts maintain the physical structure of the epineurium, perineurium, and endoneurial tubes, which are rapidly revascularized and repopulated with host cells.