Recovery of sensibility after digital neurorrhaphy: a clinical investigation of prognostic factors.

Abstract

A multicenter retrospective review of 172 epineural digital nerve repairs using microsurgical techniques was performed. A total of 71 men and 25 women ranged in age from 5 to 64 years (mean age, 33.3 years). Sharp injuries occurred in 55.6% of patients and mild crush occurred in 44.4%. Isolated nerve injuries occurred in only 24.6% of patients. The majority of digital nerve injuries involved other structures: flexor tendons (33.5%), tendons and fractures (9.0%), and fractures (4.2%). Replantations were performed in 18 digits (21.6%) and revascularizations in 7 digits (7.2%). Injury to repair was less than 1 day in 47.8%, 2 to 7 days in 22.6%, 8 to 30 days in 23.3%, and 31 to 300 days in 6.3%. Follow-up averaged 22.2 months (range, 6-77 months). The authors found a significant correlation between age and recovery of sensibility as measured by Weber's two-point discrimination test (p < 0.001). Patients older than 40 years demonstrated significantly poorer recovery of sensibility than patients younger than 40 years. A trend of better sensibility return was noted in the younger age decades (<40) with declining age; however, the intergroup differences were not significant. There was also a significant correlation between severity of injury and recovery of sensibility (p < 0.001). Sharp injuries (8.2 mm) demonstrated significantly improved recovery of sensibility compared with mild crush (10.8 mm). Fractures (11.1 mm), fractures and tendon involvement (11.4 mm), and replantations (11.8 mm) demonstrated significantly diminished recovery of sensibility compared with isolated nerve injuries (7.9 mm), tendon involvement (8.1 mm), and revascularizations (9.3 mm). There did not appear to be any significant difference in recovery of sensibility according to gender, digit involved, radial or ulnar side of digit, median or ulnar nerve distribution, level of injury (except for the metacarpophalangeal joint and the distal palmar crease where most replantations occurred), or time interval from injury to repair. There was a weak negative correlation between length of follow-up and recovery of sensation.