Abstract
Background
There are very few studies comparing patients with and without repair after digital nerve injury. It is still controversial whether digital nerve repair is necessary.
Aims
The aim of this study was to evaluate the long-term clinical outcomes of patients with unilateral isolated digital nerve injury who underwent surgical repair and those who did not.
Methods
Seventy-four patients with unilateral digital nerve injury were included in the study. Of these, the patients who underwent surgical repair were determined as group A (n = 42), the patients without repair as group B (n = 32), and the groups were divided into subgroups according to injury levels. Results were evaluated with a minimum follow-up of 24 months.
Results
When the S2PD results were evaluated overall, it was found that those who had digital nerve repair (group A) had significantly better outcomes compared to those without repair (group B) (p = 0.012). When the subgroups were evaluated according to the injury localization, no significant difference was observed at the distal levels, while it was observed that the patients who underwent repair in the proximal levels showed significantly better results (p = 0.003, p = 0.012).
Conclusion
In this study, it was seen that there was no difference between the results of repair and non-repair of unilateral nerve injuries distal to the middle level of the middle phalanx, but repair is required in injuries proximal to this level.
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References
Manley OWG, Wormald JCR, Furniss D (2019) The changing shape of hand trauma: an analysis of Hospital Episode Statistics in England. J Hand Surg Eur Vol 44:532–536. https://doi.org/10.1177/1753193419828986
Thorsén F, Rosberg H-E, Steen Carlsson K, Dahlin LB (2012) Digital nerve injuries: epidemiology, results, costs, and impact on daily life. J Plast Surg Hand Surg 46:184–190. https://doi.org/10.3109/2000656X.2012.676554
Means KR, Rinker BD, Higgins JP et al (2016) A multicenter, prospective, randomized, pilot study of outcomes for digital nerve repair in the hand using hollow conduit compared with processed allograft nerve. HAND 11:144–151. https://doi.org/10.1177/1558944715627233
Chevrollier J, Pedeutour B, Dap F, Dautel G (2014) Evaluation of emergency nerve grafting for proper palmar digital nerve defects: a retrospective single centre study. Orthop Traumatol Surg Res 100:605–610. https://doi.org/10.1016/j.otsr.2014.05.018
Lohmeyer JA, Sommer B, Siemers F, Mailänder P (2009) Nerve injuries of the upper extremity—expected outcome and clinical examination. Plast Surg Nurs 29:88–93. https://doi.org/10.1097/01.PSN.0000356867.18220.73
He B, Zhu Q, Chai Y et al (2015) Safety and efficacy evaluation of a human acellular nerve graft as a digital nerve scaffold: a prospective, multicentre controlled clinical trial. J Tissue Eng Regen Med 9:286–295. https://doi.org/10.1002/term.1707
Dunlop RLE, Wormald JCR, Jain A (2019) Outcome of surgical repair of adult digital nerve injury: a systematic review. BMJ Open 9:e025443. https://doi.org/10.1136/bmjopen-2018-025443
Oruç M, Ozer K, Çolak Ö et al (2016) Does crossover innervation really affect the clinical outcome? A comparison of outcome between unilateral and bilateral digital nerve repair. Neural Regen Res 11:1499. https://doi.org/10.4103/1673-5374.191226
Chow SP, Ng C (1993) Can a divided digital nerve on one side of the finger be left unrepaired? J Hand Surg 18:629–630. https://doi.org/10.1016/0266-7681(93)90020-G
He B, Zhu Z, Zhu Q et al (2014) Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries. Neural Regen Res 9:661. https://doi.org/10.4103/1673-5374.130094
Haug A, Bartels A, Kotas J, Kunesch E (2013) Sensory recovery 1 year after bridging digital nerve defects with collagen tubes. J Hand Surg Am 38:90–97. https://doi.org/10.1016/j.jhsa.2012.10.017
Moberg E (1962) Criticism and studvy of methods for examining sensibility in the hand*. Neurology 12:8–8. https://doi.org/10.1212/WNL.12.1.8
Mermans JF, Franssen BBGM, Serroyen J, van der Hulst RRWJ (2012) Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair. HAND 7:233–241. https://doi.org/10.1007/s11552-012-9433-1
Yildiran G, Sutcu M, Akdag O, Tosun Z (2020) Long-term outcomes of digital nerve repair accompanied by digital artery injury in flexor zone 2. Surg J 06:e7–e9. https://doi.org/10.1055/s-0039-3400229
Bowden JL, McNulty PA (2013) Age-related changes in cutaneous sensation in the healthy human hand. Age (Omaha) 35:1077–1089. https://doi.org/10.1007/s11357-012-9429-3
Al-Ghazal SK, Kiernan MM, Khan K, Cann JM (1994) Results of clinical assessment after primary digital nerve repair. J Hand Surg 19:255–257. https://doi.org/10.1016/0266-7681(94)90180-5
Piquet M, Obert L, Laveaux C et al (2010) Influence de la perméabilité de l’artère digitale palmaire sur la récupération nerveuse dans les lésions des nerfs digitaux palmaires. Chir Main 29:94–99. https://doi.org/10.1016/j.main.2009.12.004
Dautel G, MERLE M (1992) The blood supply of digital nerves: a microanatomical study of superficial and deep palmar venous networks. J Hand Surg 17:632–637. https://doi.org/10.1016/0266-7681(92)90189-9
Godde B, Stauffenberg B, Spengler F, Dinse HR (2000) Tactile coactivation-induced changes in spatial discrimination performance. J Neurosci 20:1597–1604. https://doi.org/10.1523/JNEUROSCI.20-04-01597.2000
Lundborg G, ROSÉN B (2004) The two-point discrimination test – time for a re-appraisal? J Hand Surg 29:418–422. https://doi.org/10.1016/J.JHSB.2004.02.008
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Pamuk, Ç. Digital nerve injury: to repair or not?. Ir J Med Sci 192, 2235–2241 (2023). https://doi.org/10.1007/s11845-022-03268-4
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DOI: https://doi.org/10.1007/s11845-022-03268-4