Abstract
BackgroundOptimal surgical management of digital nerve lesions remains uncertain despite the publication of numerous studies. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery.MethodsA literature search was performed using PubMed including citation from MEDLINE. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Further, the sensory outcome had to be assessed according to the modified American Society for Surgery of the Hand guidelines to stratify for two-point discrimination in millimeters. The variables age, follow-up, delay in repair, type of trauma, and gap length were extracted. The association between each predictor and response was assessed using a linear mixed model and corrected for heterogeneity between studies. Significance was considered present at p ≤ 0.05.ResultsOf the 34 articles found, 14 articles were included giving appropriate individual data for 191 nerves. There was no statistically significant difference in outcome between operation techniques. Age and follow-up were verified predictors of sensory recovery.ConclusionIn this review, the type of operation for digital nerve repair does not influence sensory outcome. However, we verified outcome to be influenced by the patient’s age and the follow-up period. To add more scientific evidence to our results, larger cohort prospective studies need to be done with better detailed description of data.
Highlights
Digital nerve lacerations are common in hand trauma surgery and are even the most frequently injured of the peripheral nerves
In case a digital nerve is left unrepaired, the axonal growth will disperse and could lead to neuroma formation which would interfere with rehabilitation, functional recovery, and sensory deficit especially in the thumb and the second digit which are involved in pinch and gnostic function [43]
Primary repair by end-to-end neurorrhaphy can be performed in about 82 % of the cases [28]
Summary
Digital nerve lacerations are common in hand trauma surgery and are even the most frequently injured of the peripheral nerves. Digital nerve injury can result from simple cuts or from severe hand trauma. Since Moberg [36] studied and described the sensory function of the fingers, many studies reported the treatment and the evaluation of the sensibility after treatment of nerve injuries. Primary repair by end-to-end neurorrhaphy can be performed in about 82 % of the cases [28]. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Age and follow-up were verified predictors of sensory recovery
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