Sensory recovery after primary repair of palmar digital nerves using a Revolnerv® collagen conduit: A prospective series of 27 cases

Abstract

Despite advances in microsurgery, digital nerve repair remains a challenge due to the lack of reproducible procedures with satisfactory functional results. The aim of this study was to compare the sensory and functional results of direct microsurgical sutures protected by a Revolnerv® nerve regeneration conduit, with results of a series of direct sutures without a protective conduit in the literature. From November 2009 to April 2010, 35 patients were treated by direct epiperineural suture for digital nerve injury, protected by a Revolnerv® nerve regeneration conduit at the FESUM centre “SOS-mains Lesquin/CHRU de Lille”. Sensory recovery was assessed by the static two-point discrimination Weber test (WS) and the Semmes-Weinstein (SW) test at postoperative months 1, 3, and 6. The final evaluation was performed after a minimum follow-up of 6 months. Statistical analysis of sensory results (WS and SW) was mainly performed with non-parametric tests (Wilcoxon, Mann and Whitney). P<0.05 was considered to be statistically significant. One patient was excluded, six were lost to follow-up, and four could not be seen at the 6-month follow-up visit. Finally, 24 patients and 27 nerve sutures were included. Mean age was 38 years old and the ratio of women/men was 1/5. Eighty-five percent of the patients had useful (S3+) or normal (S4) discrimination at 6 months, and the average WS was 10.3 (±3.76). There was a tendency to better WS results in sharp transections compared to jagged lacerations (9.19 vs 11.82). The SW test was satisfactory in 15% of patients and acceptable in 30%. There were no complications from the Revolnerv® collagen tube. After 6 months follow-up this study shows that results with the Revolnerv® nerve regeneration conduit on direct palmar digital nerve sutures were comparable to but not better than those of uncoated direct sutures. A study including a larger population with longer follow-up is necessary to determine the value of this technique and its recommendation for general use in all digital nerve injuries.