AVANCE is an acellular nerve scaffold indicated for the treatment of adult and pediatric patients aged one month and older with:
AVANCE is available in 16 combination sizes with the following dimensions:
AVANCE may vary in color from white, off-white, pink, pale pink, and yellow to pale yellow. (3)
None. (4)
The most common adverse reactions (incidence ≥2%) were procedural pain (4%) and hyperesthesia (3%). (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact Customer Care at 1-888-296-4361 or customercare@axogeninc.com or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION.
Revised: 1/2026
AVANCE is indicated for the treatment of adult and pediatric patients aged one month and older with sensory nerve discontinuity ≤25 mm.
AVANCE is indicated for the treatment of adult and pediatric patients aged one month and older with peripheral sensory nerve discontinuity >25 mm.
This indication is approved under accelerated approval based on improvement in static two-point discrimination (s2PD) at 12 months in sensory nerve gaps ≤ 25 mm, which provided empirical evidence to reasonably predict clinical benefit given similarities in pathophysiology and anticipated therapeutic effects. [see Clinical Studies (14)]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory clinical trials.
AVANCE is indicated for the treatment of adult and pediatric patients aged one month and older with mixed and motor nerve discontinuity.
This indication is approved under accelerated approval based on improvement in s2PD at 12 months in sensory nerve gaps, which provided empirical evidence to reasonably predict clinical benefit given similarities in pathophysiology and anticipated therapeutic effects. [see Clinical Studies (14)]. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory clinical trial.
AVANCE is intended for surgical implantation.
Refer to Table 1 for the available sizes of AVANCE:
| Length (mm) | Diameter Range (mm)* | Length Range (mm)* |
|---|---|---|
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|
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|
15 |
1 to 2 |
15 to 21 |
|
15 |
2 to 3 |
15 to 21 |
|
15 |
3 to 4 |
15 to 21 |
|
15 |
4 to 5 |
15 to 21 |
|
30 |
1 to 2 |
30 to 36 |
|
30 |
2 to 3 |
30 to 36 |
|
30 |
3 to 4 |
30 to 36 |
|
30 |
4 to 5 |
30 to 36 |
|
50 |
1 to 2 |
50 to 56 |
|
50 |
2 to 3 |
50 to 56 |
|
50 |
3 to 4 |
50 to 56 |
|
50 |
4 to 5 |
50 to 56 |
|
70 |
1 to 2 |
70 to 76 |
|
70 |
2 to 3 |
70 to 76 |
|
70 |
3 to 4 |
70 to 76 |
|
70 |
4 to 5 |
70 to 76 |
Receipt and Storage of AVANCE:
AVANCE is shipped on dry ice in validated insulated shipping containers. AVANCE must remain frozen at ≤-40°C (≤-40°F) and be kept frozen until use. For a complete description of the AVANCE packaging configuration and storage conditions, [see How Supplied/Storage and Handling (16)].
AVANCE is to be prepared in an appropriate surgical environment.
Supplies:
The following supplies are not included but are needed for preparation:
Preparation Instructions:
Following standard surgical site preparation for exposure, mobilization, and trimming of the peripheral nerve to be treated, determine the size and/or number of AVANCE that need to be thawed. [see Dosage and Administration (2.3)].
The following instructions are for preparing one AVANCE. Two team members (one sterile field team member and one team member outside the sterile field) are required.
If two or more AVANCE are required, prepare them individually. AVANCE thawing should take approximately 6 minutes.
Figure 1: Thawing AVANCE with sterile saline or LRS.
Figure 1: Thawing AVANCE with sterile saline or LRS.
AVANCE is implanted in appropriate sterile conditions by a trained licensed physician. Follow the steps below for surgical implantation of AVANCE:
AVANCE will vary in color from white, off-white, pink, pale pink, and yellow to pale yellow. AVANCE is a sterile, surgical implant and is intended for administration to a single patient. The available sizes of AVANCE are provided in Table 1.
Procedural complications have occurred with the AVANCE implantation procedure and have included pain, hyperesthesia, infection, implant site swelling, adhesions, hypertrophic scar formation, impaired motor or sensory function, bleeding, and neuroma formation [see Adverse Reactions (6)]. Additional procedural complications may include risk of bleeding and complications related to anesthesia. Monitor patients for procedural complications with AVANCE implantation and manage accordingly.
Transmission of infectious diseases or agents may occur with AVANCE administration, as it is manufactured using tissues from human cadaveric donors. Donors are screened and tested for Human Immune-deficiency Virus 1 (HIV-1); Human Immune-deficiency Virus 2 (HIV-2); Hepatitis B Virus (HBV); Hepatitis C Virus (HCV); and Syphilis (Treponema pallidum). Additional testing for Human T-cell Leukemia-lymphoma Virus 1 (HTLV-1) and Human T-cell Leukemia-lymphoma Virus 2 (HTLV-2) may be performed as required by local regulatory authorities in US states. Only screening was performed for Creutzfeldt-Jakob disease (CJD). These measures do not eliminate the risk of transmitting these or other infectious diseases or agents.
All infections thought to be transmitted by AVANCE should be reported to Axogen Corporation at 1‑888-296-4361.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in one clinical trial cannot be directly compared to rates in other clinical trials and may not reflect the rates observed in practice.
The safety database described in this section reflects exposure to AVANCE in the RECON Study. A total of 112 patients received AVANCE and 108 patients received NeuraGen® (bovine nerve cuff) and were followed for a duration of 12 months. [see Clinical Studies (14)].
A serious adverse reaction occurred in 1 patient, which was wound dehiscence.
Table 2 lists the most common adverse reactions that occurred in ≥ 2% of patients in the RECON Study.
|
Adverse Reactions |
AVANCE n (%) |
Bovine Nerve Cuff n (%) |
|
Implant site hyperesthesia |
3 (3) |
5 (5) |
|
Procedural pain |
4 (4) |
0 |
Other clinically significant adverse reactions that occurred in <2% of patients in AVANCE group include: implant site swelling (n=2), paraesthesia (n=2), hypertrophic scar (n=2), pyogenic granuloma (n=2), grade 3 neuroma (n=1), wound dehiscence (n=1), tendon adhesion (n=1), implant site nodule (n=1), osteomyelitis (n=1), and dermal cyst (n=1).
Adverse Reactions from Observational Studies
The safety of AVANCE was evaluated in an ongoing, multicenter, observational registry study in patients undergoing nerve repair. The registry assessed repairs using the Medical Research Council Classification (MRCC) across nerve types (sensory, motor, and mixed), gap lengths (5–210 mm), and body regions (upper extremity, head and neck, torso including breast, and lower extremity).
Adverse reactions reported in the study include neuroma, seromas, implant site infection, tissue necrosis, nerve regeneration failure, hyperesthesia, hypoesthesia, AVANCE implantation error, and hematoma.
There are no data on the use of AVANCE in pregnant women. No animal reproductive and developmental toxicity studies have been conducted with AVANCE to assess whether it can cause harm to the mother or fetus when administered to a pregnant woman.
In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.
The safety and effectiveness of AVANCE have been established in pediatric patients aged one month and older. The use of AVANCE in pediatric patients for the treatment of nerve discontinuity was supported by extrapolation of adult data from the RECON Study. [see Clinical Studies (14)].
AVANCE (acellular nerve allograft-arwx) is a sterile, acellular nerve scaffold derived from human cadaveric peripheral nerve tissue for surgical implantation. The processing method maintains the three-dimensional scaffold of the native peripheral nerve, including the endoneurial tubes, perineurium, epineurium, and microvasculature of the extracellular matrix (ECM). The processing removes cellular and noncellular components, including cells, fat, blood, axonal debris, and glycosaminoglycans. AVANCE is saturated in Lactated Ringer’s Solution prior to packaging and storage.
AVANCE is an acellular nerve scaffold intended to restore nerve function in the distal tissue.
AVANCE provides structural and biochemical cues for axonal regeneration. The structural cue is provided by the intact endoneurial tubes. The biochemical cue is provided by the basement membrane proteins of the endoneurial tubes. The basement membrane of the endoneurial tubes includes many proteins, such as collagen, laminin, fibronectin, and proteoglycans. The laminin lining the endoneurial tubes of AVANCE has been shown in in vitro assays and animal studies to be bioactive by supporting Schwann cell migration, axon growth cone interactions, and neurite extension. Without the specific bioactive laminin composition, the neuroregenerative capacity is hindered. However, the exact mechanism of action is unknown.
The efficacy of AVANCE was evaluated in a multicenter, prospective, randomized, patient- and evaluator-blinded study that compared implantation of AVANCE to implantation of NeuraGen nerve cuff (RECON; NCT01809002). The study enrolled adult patients with sustained injury to at least one sensory nerve, distal to the superficial palmar arch and proximal to the distal interphalangeal joint, and a nerve gap between 5 mm and 25 mm. Patients with nerve injuries longer than 24 weeks, injuries requiring replantation of the target digit, injuries with vascular damage resulting in inadequate perfusion despite repair, prior history of type 1 Diabetes Mellitus or type 2 Diabetes Mellitus requiring regular insulin therapy, and prior history of neuropathy were excluded.
A total of 220 patients were intraoperatively randomized in a 1:1 ratio to receive either AVANCE (n=112) or NeuraGen (n=108). Randomization was stratified based on nerve gap length (5–14 mm: Group A; 15–25 mm: Group B).
The population demographics were as follows: the median age was 37 years (range 18 to 69 years), and 155 patients (71%) were male. 174 patients (79%) were White, 33 patients (15%) were Black, 3 patients (1.4%) were Hispanic or Latino, 2 patients (0.9%) were Asian, 2 patients (0.9%) were Native Hawaiian or Pacific Islander, and 6 patients (2.7%) were of “other race”.
The primary efficacy outcome measure was improvement in static two-point discrimination (s2PD) in the target digit, with a non-inferiority test (non-inferiority margin of -2 mm) between the groups at 12 months following reconstruction.
The efficacy results are summarized in Table 3 below.
| a Estimated using repeated measures Analysis of Covariance (ANCOVA) model with fixed effects for repair type, visit, and gap length and a random effect for subject. Visits Pre-Op screening, Months 1, 3, 6, 9, and 12 were included. CI=confidence interval; LS= least squares; mm=millimeter |
|||
|
Endpoints |
AVANCE |
Nerve Cuff |
LS mean difference |
|
Static two-point discrimination (s2PD) in the target digit at 12 monthsa LS mean (95% CI) |
9.1 mm (8.11, 10.04) |
9.4 mm (8.50, 10.30) |
0.3 mm (-0.98, 1.64) |
AVANCE is shipped on dry ice and supplied frozen, as a single, intact graft of varying color from white, off-white, pink, pale pink, and yellow to pale yellow. Do not use if broken or otherwise compromised.
AVANCE is sterile packaged. The immediate container closure system consists of a clamshell (thermoformed tray) within two pouches, a sealed Tyvek-poly pouch within a foil-poly pouch. The foil-poly pouch is the sterile barrier for AVANCE. The immediate container closure system is packaged in a commercial carton, which is sealed with a Carton Seal Tape and placed in a zip top bag for freezer storage protection, see Figure 2.
| Length (mm) | Diameter (mm) | NDC Numbers |
|---|---|---|
|
15 |
1 to 2 |
84545-115-01 |
|
15 |
2 to 3 |
84545-215-01 |
|
15 |
3 to 4 |
84545-315-01 |
|
15 |
4 to 5 |
84545-415-01 |
|
30 |
1 to 2 |
84545-130-01 |
|
30 |
2 to 3 |
84545-230-01 |
|
30 |
3 to 4 |
84545-330-01 |
|
30 |
4 to 5 |
84545-430-01 |
|
50 |
1 to 2 |
84545-150-01 |
|
50 |
2 to 3 |
84545-250-01 |
|
50 |
3 to 4 |
84545-350-01 |
|
50 |
4 to 5 |
84545-450-01 |
|
70 |
1 to 2 |
84545-170-01 |
|
70 |
2 to 3 |
84545-270-01 |
|
70 |
3 to 4 |
84545-370-01 |
|
70 |
4 to 5 |
84545-470-01 |
Contact Axogen Customer Care at 888-296-4361 for any issues with the condition of the packaging or graft, or for further instructions.
Discuss the following with the patient and/or caregivers.
Axogen Corporation
13631 Progress Blvd., Suite 400
Alachua, FL 32615
www.axogeninc.com
U.S. License #2340
AVANCE® is a registered trademark of Axogen Corporation.
NeuraGen® is a registered trademark of Integra LifeSciences Corporation.
Tyvek® is a registered trademark of E.I. DuPont De Nemours & Co.
© 2025 Axogen Corporation
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processed nerve allograft implant |
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| Labeler - Axogen Corporation (113424464) |