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Dr Tam have collected the first 20 patients for interim analysis per the protocol, and are trying to get these data to perform interim analyses on these data to best understand how to move forwards.
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Perform a preliminary efficacy study using the porcine extracellular matrix nerve wrap (AxoGuard Nerve Protectorâ„¢, AxoGen Inc., Alachua, FL) to wrap the spinal accessory nerve (SAN) during neck dissections for head and neck cancer as it relates to postoperative shoulder function, both subjectively and objectively.
Many patients who have surgery for head and neck cancer also need a procedure called a neck dissection, where lymph nodes and tissue are removed from the neck. During this surgery, even when a nerve called the spinal accessory nerve (SAN) is carefully preserved, patients often have shoulder problems afterward. These problems can include pain, weakness, and difficulty lifting the arm, which can affect daily activities and quality of life.
This study is testing whether using a special nerve wrap made from pig tissue (called AxoGuard® Nerve Protector) can help protect the spinal accessory nerve during surgery and improve shoulder movement and strength after surgery. This nerve wrap is already used in other types of nerve surgeries and may help the nerve heal better by reducing scar tissue and irritation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment Arm - Neck dissection with AxoGuard Nerve Protectorâ„¢ | Experimental | Participants undergo neck dissection surgery for head and neck cancer, during which the spinal accessory nerve (SAN) is wrapped with the AxoGuard Nerve Protectorâ„¢ (porcine extracellular matrix nerve wrap). This intervention aims to improve postoperative shoulder function by protecting and supporting the nerve during healing. Postoperative physical therapy evaluations will be conducted at baseline, immediate post-op, 1, 6, and 12 months. |
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| Control Arm - Neck dissection without AxoGuard Nerve Protectorâ„¢. | No Intervention | Participants undergo standard neck dissection surgery for head and neck cancer without the application of the AxoGuard Nerve Protectorâ„¢. Postoperative physical therapy evaluations will be conducted at baseline, immediate post-op, 1, 6, and 12 months to assess shoulder function. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Porcine Extracellular Matrix Nerve Wrap (AxoGuard Nerve Protectorâ„¢) | Device | The intervention involves the application of the AxoGuard Nerve Protectorâ„¢, a nerve wrap derived from porcine extracellular matrix (ECM), to the spinal accessory nerve (SAN) during neck dissection surgery in head and neck cancer patients. The device is designed to protect and support the nerve by preserving the extracellular matrix and creating a favorable environment for nerve healing. This helps prevent inflammation and fibrosis around the nerve, potentially improving postoperative shoulder function. The nerve wrap is applied intraoperatively after dissection but before surgical closure. The study compares this intervention to standard neck dissection without nerve wrapping. |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in shoulder flexion active range of motion (degrees) | Shoulder flexion active range of motion will be measured using goniometry. A clinically significant decline is defined as a ≥12° decrease compared to preoperative baseline. Unit of Measure: Degrees | From preoperative baseline assessment up to 12 months post-surgery |
| Change from baseline in Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score | Subjective upper extremity function will be assessed using the QuickDASH questionnaire (0-100 scale, higher scores indicate worse disability). Unit of Measure: Score | From preoperative baseline assessment up to 12 months post-surgery |
| Change from baseline in Neck Dissection Impairment Index (NDII) score | Subjective shoulder-related quality of life will be assessed using the NDII questionnaire (0-50 scale, higher scores indicate greater impairment). Unit of Measure: Score | From preoperative baseline assessment up to 12 months post-surgery |
| Change from baseline in shoulder abduction active range of motion (degrees | Shoulder abduction active range of motion will be measured using goniometry. A clinically significant decline is defined as a ≥23° decrease compared to preoperative baseline. Unit of Measure: Degrees | From preoperative baseline assessment up to 12 months post-surgery |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Samantha Tam, MD | Henry Ford Health System | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Henry Ford Health System | Detroit | Michigan | 48202 | United States |
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| ID | Term |
|---|---|
| D006258 | Head and Neck Neoplasms |
| D011183 | Postoperative Complications |
| D061227 | Accessory Nerve Injuries |
| D009408 | Nerve Compression Syndromes |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| D020436 | Accessory Nerve Diseases |
| D003389 | Cranial Nerve Diseases |
| D009422 | Nervous System Diseases |
| D020209 | Cranial Nerve Injuries |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D014947 | Wounds and Injuries |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |