Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review

Abstract

Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.

Cold sensitivity, functional disability and predicting factors after a repaired digital nerve injury

“…The present study of individuals with a repaired digital nerve injury can be considered as representative for a total population 13 , 21 , 25 , where men are overrepresented, and the affected individuals are generally young 22 . We only included primary digital nerve repairs, excluding nerve grafts; thus, we present a more homogenous patient population in contrast to previous studies including different surgical methods, such as novel nerve allografts 5 , 26 , although such surgical procedures all are reported to provide a reasonable outcome 27 , 28 . Digital nerve injuries often present with concomitant injuries, such as fractures as well as vascular, joint/ligament, flexor tendon and multiple injuries.…”

A systematic review and meta-analysis of studies comparing muscle-in-vein conduits with autologous nerve grafts for nerve reconstruction

“…Second, clinical studies of peripheral nerve repair most commonly feature injuries of digital nerves, which are relatively small and monofascicular 35 . In opposite, mixed (motor and sensory) multifascicular nerves are most commonly studied in preclinical studies.…”

Prevalence of post-traumatic neuropathic pain after digital nerve repair and finger amputation

“…These patients were excluded because the use of auto or allografts could interfere with the outcome. 32 Besides the peripheral element of the etiology of nerve repair after nerve injury, there is a central component. Minutes after the transection of a peripheral nerve, cortical remapping occurs.…”