Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
HAND
Published in: HAND 3/2012

Open Access 01-09-2012 | Review Articles of Topics

Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair

Authors: Joline F. Mermans, Bas B. G. M. Franssen, Jan Serroyen, Rene R. W. J. Van der Hulst

Published in: HAND | Issue 3/2012

Login to get access

Abstract

Background

Optimal 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.

Methods

A 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.

Results

Of 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.

Conclusion

In 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.
Literature
1.
Al-Ghazal SK, McKiernan M, Khan K, et al. Results of clinical assessment after primary digital nerve repair. J hand Surg. 1994;19B:255–7.
2.
Al-Qattan MM. Terminolateral neurorrhaphy: review of experimental and clinical studies. J Reconstr Microsurg. 2001;17:99–108.PubMedCrossRef
3.
Altissimi M, Mancini GB, Azzarà A. Results of primary repair of digital nerves. J Hand Surg. 1991;16B:546–7.
4.
American Society for Surgery of the Hand. History and general examination. The hand examination and diagnosis. 2nd ed. New York: Churchill Livingstone; 1983. p. 3–10.
5.
Artiaco S, Tos P, Conforti LG, et al. Termino-lateral nerve suture in lesions of the digital nerves: clinical experience and literature review. J Hand Surg. 2010;35B:109–14.
6.
Battiston B, Geuna S, Ferrero M, et al. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery. 2005;25:258–67.PubMedCrossRef
7.
Battiston B, Tos P, Conforti LG, et al. Alternative technique for peripheral nerve repair: conduits and end-to-side neurorraphy. Acta Neurochir Suppl. 2007;100:43–50.PubMedCrossRef
8.
Berger A, Mailänder P. Advances in peripheral nerve repair in emergency surgery of the hand. World J Surg. 1991;15:493–500.PubMedCrossRef
9.
Berger A, Millesi H. Nerve grafting. Clin Orthop Relat Res. 1978;133:49–55.PubMed
10.
Brown PW. Factors influencing the success of the surgical repair of peripheral nerves. Surg Clin North. 1972;52A:1137–55.
11.
Bushnell BD, McWilliams AD, Whitener GB, et al. Early clinical experience with collagen nerve tubes in digital nerve repair. J Hand Surg. 2008;33A:1081–7.
12.
Cook DJ, Guyatt GH, Laupacis A, et al. Clinical recommendations using levels of evidence for antithrombotic agents. Chest 1995; 108(4 Suppl):227S–230S.
13.
Cheng AS, Hung L, Wong JM, et al. A prospective study of early tactile stimulation after digital nerve repair. Clin Orthop Relat Res. 2001;384:169–75.PubMedCrossRef
14.
Chiu DT, Strauch B. A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less. Plast Reconstr Surg. 1990;86:928–34.PubMedCrossRef
15.
Dellon AL, Mackinnon SE, Crosby PM. Reliability of two point discrimination measurements. J Hand Surg. 1987;12:693–6.
16.
Efstathopoulos D, Gerostathopoulos N, Misitzis D, et al. Clinical assessment of primary digital nerve repair. Acta Orthop Scand Suppl. 1995;264:45–7.PubMed
17.
Ferdindandez E, Lauretti L, Tufo T, et al. End-to-side nerve neurrorraphy: critical appraisal of experimental clinical data. Acta Neurochir Suppl. 2007;100:77–84.CrossRef
18.
Frey M, Giovanoli P. End-to-side neurorraphy of sensory nerves. Eur J Plast Surg. 2003;26:85–8.CrossRef
19.
Goldie BS, Coates CJ, Birch R. The long term results of digital nerve repair in no-man’s land. J Hand Surg. 1992;17B:75–7.
20.
Green DP, Hotchkiss RN, Pederson WC. Operative hand surgery, 4th ed., vols. 1 and 2. Philadelphia: Churchill Livingstone; 1998.
21.
Hirasawa Y, Katsumi Y, Tokioka T. Evaluation of sensibility after sensory reconstruction of the thumb. J Bone Joint Surg. 1985;67B:814–9.
22.
Johnson EO, Soucacos PN. Nerve repair: experimental and clinical evaluation of biodegradable artificial nerve guides. Injury. 2008;39 Suppl 3:S30–6.PubMedCrossRef
23.
Kaas JH, Merzenich MM, Killackey HP. The reorganization of somatosensory cortex following peripheral nerve damage in adult and developing mammals. Annu Rev Neurosci. 1983;6:325–56.PubMedCrossRef
24.
Kallio PK. The results of secondary repair of 254 digital nerves. J Hand Surg. 1993;18B:327–30.
25.
Kallio PK, Vastamaki M. An analysis of the results of late reconstruction of 132 median nerves. J Hand Surg. 1993;18B:97–105.
26.
Lee YH, Shieh SJ. Secondary nerve reconstruction using vein conduit grafts for neglected digital nerve injuries. Microsurgery. 2008;28:436–40.PubMedCrossRef
27.
Lee SK, Wolfe SW. Peripheral nerve injury and repair. J Acad Orthop Surg. 2000;8A:243–52.
28.
Lohmeyer JA, Siemers F, Machens HG, et al. The clinical use of artificial nerve conduits for digital nerve repair: a prospective cohort study and literature review. J Reconstr Microsurg. 2009;25:55–61.PubMedCrossRef
29.
Lundborg G, Rosén B. Hand function after nerve repair. Acta Physiol. 2007;189:207–17.CrossRef
30.
Mackinnon SE, Dellon AL. A study of nerve regeneration across synthetic (maxon) and biologic (collagen) nerve conduits for nerve gaps up to 5 cm in the primate. J Reconstr Microsurg. 1990;6:117–21.PubMedCrossRef
31.
Mailänder P, Berger A, Schaller E, et al. Results of primary nerve repair in the upper extremity. Microsurgery. 1989;10:147–50.PubMedCrossRef
32.
Marcoccio I, Vigasio A. Muscle-in-vein nerve guide for secondary reconstruction in digital nerve lesions. J Hand Surg. 2010;35A:1418–126.
33.
Meek MF, Coert JH. Clinical use of nerve conduits in peripheral nerve repair: review of the literature. J Reconstr Microsurg. 2002;18:97–109.PubMedCrossRef
34.
Meek MF, Coert JH, Robinson PH. Poor results after nerve grafting in the upper extremity: quo vadis? Microsurgery. 2005;25:396–402.PubMedCrossRef
35.
36.
Moberg E. Criticism and study of methods for examining sensibility in the hand. Neurology. 1962;12:8–19.PubMedCrossRef
37.
Norris RW, Glasby MA, Gattuso JM, et al. Peripheral nerve repair in humans using muscle autografts. A new technique. J Bone Joint Surg. 1988;70B:530–3.
38.
Nunley JA, Saies AD, Sandow MJ, et al. Results of interfascicular nerve grafting for radial nerve lesions. Microsurgery. 1996;17:431–7.PubMedCrossRef
39.
Nunley JA, Ugino MR, Goldner RD, et al. Use of the anterior branch of the medial antebrachial cutaneous nerve as a graft for the repair of defects of the digital nerve. J Bone Joint Surg. 1989;71A:563–7.
40.
Pélissier P, Riahi R, Casoli V, et al. Terminal–lateral nerve anastomoses. Preliminary clinical report of two cases. Ann Chir Plast Esthet. 2001;46:129–33.PubMedCrossRef
41.
Poppen NK, McCarroll HR, Doyle JR, et al. Recovery of sensibility after suture of digital nerves. H Hand Surg. 1979;4A:212–25.
42.
Rinker B, Liau JY. A prospective study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. J Hand Surg. 2011;36A:775–81.
43.
Risitano G, Cavallaro G, Cavallaro T, et al. Clinical results and thoughts on sensory nerve repair by autologous vein grafts in emergency hand reconstruction. Chir Main. 2002;21:194–7.PubMedCrossRef
44.
Segalman KA, Cook PA, Wang BH, et al. Digital neurorrhaphy after the age of 60 years. J Reconstr Microsurg. 2001;17:85–8.PubMedCrossRef
45.
Steinberg DR, Koman LA. Factors affecting the results of peripheral nerve repair. In: Gelberman RH, editor. Operative nerve repair and reconstruction. Philadelphia: JB Lippincott; 1991. p. 349–64.
46.
Strauch B. Use of nerve conduits in peripheral nerve repair. Hand Clin. 2000;16:123–30.PubMed
47.
Sullivan DJ. Results of digital neurorraphy in adults. J Hand Surg. 1985;10B:41–4.
48.
Tadjalli HE, McIntyre FH, Dolynchuk KN, et al. Digital nerve repair: relationship between severity of injury and sensibility recovery. Ann Plast Surg. 1995;35:36–40.PubMedCrossRef
49.
Tang JB. Vein conduits with interposition of nerve tissue for peripheral nerve defects. J Reconstr Microsurg. 1995;11:21–6.PubMedCrossRef
50.
Tang JB, Gu YQ, Song YS. Repair of digital nerve defect with autogenous vein graft during flexor tendon surgery in zone 2. J Hand Surg. 1993;18B:449–53.
51.
Viterbo F, Trinidade JC, Hoshino K, et al. Latero-terminal neurorraphy without removal of epineural sheath. Experimental study in rats. Rev Paul Med. 1992;110:267–75.PubMed
52.
Viterbo F, Trinidade JC, Hoshino K, et al. Two end-to-side neurorrhapies and nerve grafts with removal of epineural sheaths: experimental study in rats. J Plast Surg Br. 1994;47:75–80.CrossRef
53.
Voche P, Ouattara D. End-to-side neurorraphy for defects of palmar sensory digital nerves. Br J Plast Surg. 2005;58:239–44.PubMedCrossRef
54.
Walton RL, Brown RE, Matory Jr WE, et al. Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study. Plast Reconstr Surg. 1989;84:944–9.PubMedCrossRef
55.
Wang WZ, Crain GM, Baylis W, et al. Outcome of digital nerve injuries in adults. J Hand Surg. 1996;21A:138–43.
56.
Weber RA, Breidenbach WC, Brown RE, et al. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans. Plast Reconstr Surg. 2000;106:1036–45.PubMedCrossRef
57.
Weinzweig N, Chin G, Mead M, et al. Recovery of sensibility after digital neurorraphy: a clinical investigation of prognostic factors. Ann Plast Surg. 2000;44:610–7.PubMedCrossRef
58.
Witzel C, Rohde C, Bushart TM. Pathways sampling by generating peripheral axons. J Comp Neurol. 2005;485:183–90.PubMedCrossRef
Metadata
Title
Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair
Authors
Joline F. Mermans
Bas B. G. M. Franssen
Jan Serroyen
Rene R. W. J. Van der Hulst
Publication date
01-09-2012
Publisher
Springer-Verlag
Published in
HAND / Issue 3/2012
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-012-9433-1

Other articles of this Issue 3/2012

HAND 3/2012 Go to the issue

Letter to the Editor

What were the adverse events for Dupuytren’s patients treated with Xiaflex who had contractures less than 20°?

Case Reports

Concomitant compressive neuropathy of the ulnar and median nerves in the hand by midpalmar ganglion

Multimedia Articles

Elongated muscle belly of the flexor digitorum superficial causing carpal tunnel syndrome

Surgery Articles

The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating

Case Reports

A cost analysis of staged and simultaneous bilateral carpal tunnel release

Surgery Articles

Results of ulnar shortening osteotomy with a new plate compression system