Comparison of three methods on bilateral proper digital nerve injuries for repairing severed fingers

Abstract

Objective To compare the clinical efficacy of the nerve bow （digital nerve and cutaneous antebrachii later-als） with end-to-side neuroanastomosis and traditional end-to-end neuroanastomosis for repairing bilateral proper digital nerve inju-ries while replanting injured fingers. Methods A total of 57 patients with bilateral proper digital nerve injuries from March 2009 to September 2012 were retrospectively analyzed. The patients were divided into three groups according to different treatments：19 patients underwent nerve graft bow end-to-side neuroanastomosis. During operation, a cutaneous antebrachii laterals nerve was freed and obtained from the homolateral forearm, which were sutured with bilateral distal digital nerve end to end, then nerve bow was formed. The bilateral proximal ends of digital nerve were sutured end-to-side bow, respectively. 22 patients underwent digital nerve bow end-to-side neuroanastomosis. During operation, bilateral distal ends and proximal ends were sutured respectively;con-sequently, the distal and proximal nerve bows were formed. A cutaneous antebrachii laterals nerve was obtained from the homolat-eral forearm, then divided equally to 2 parts which were used to bridge the 2 nerve digital nerve bow end-to-side neuroanastomosis bows. 16 patients underwent nerve graft with end-to-end neuroanastomosis. The sensation of finger plup, two point discrimination and motion of joints were evaluated. Results All patients achieved primary healing of wound after operation, with 57 fingers re-covered uneventfully. In nerve graft bow end-to-side neuroanastomosis group, 18 patients were followed up for 3-15 months;the average result of sensation measurement was S3＋;the average result of two point discrimination was 5.1±0.8 mm. In digital nerve bow end-to-side neuroanastomosis group, 19 patients were followed up for 4-15 months;the average result of sensation measure-ment was S3; the average result of two point discrimination was 6.3 ± 0.9 mm. In nerve graft with end-to-end neuroanastomosis group, 12 patients were followed up for 3-14 months;the average result of sensation measurement was S2, the average result of two point discrimination was 7.2±1.4 mm. According to total active motion scales, there had no difference in results of motion of joints in the 3 groups. Conclusion The nerve bow end-to-side neuroanastomosis is valuable method for repairing bilateral proper digi-tal nerve injuries at the same time, which can restore sensation of fingers. Key words: Anastomosis; Surgical Fingers Reconstructive surgical procedures Trauma; nervous system