TDAP flap and SSG both improve QOL for patients with severe axillary HS. The TDAP flap showed greater benefits in terms of QOL, recovery, rate of complications and number of overall procedures.

T raumatic brachial plexus injuries affect 1% of patients involved in major trauma (1). Brachial plexus injuries may cause permanent disability (2-6), pain (6-8), psychologic morbidity (9,10), and reduced quality of life (2,4,11). Early reconstructive nerve surgery is associated with better functional recovery in the upper limb (2,3,11,12), which improves quality of life (4). Nerve reconstruction for patients with root avulsion(s) is a clinical priority for several reasons. After root avulsion, the cell bodies of motor neurons in the spinal cord recede (4,5,12,13), so the limb never reanimates spontaneously. Because reimplantation of avulsed roots yields no meaningful recovery (14-16), nerve transfers are performed, which significantly improves function (11,17-20). Nerve transfers are relatively minor and cost-effective procedures (21,22) with low morbidity (20,23-25). Furthermore, 95% of patients with traumatic brachial plexus injuries have neuropathic pain (6), and the evolving evidence suggests that early reconstructive nerve surgery reduces cortical reorganization and thus neuropathic or phantom limb pain (26-28). Therefore, correctly identifying patients with root avulsions is of paramount importance. MRI is the best noninvasive test for brachial plexus injuries (29). MRI is superior to nerve and muscle electrophysiology studies (30), US (31-34), and intraoperative somatosensory-evoked potentials (35). Currently, MRI

mapping reduces the operative time of DIEP flap breast reconstruction: a systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography, Journal of Plastic, Reconstructive & Aesthetic Surgery (2017), https://doi.org/10.1016/j.bjps.2017.12.012. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Page 1 There are no other sources of funding to acknowledge. Conflicts of InterestThere are no conflicts of interest. Ethical reviewEthical review was not required as this is a review of published literature. Further, this article does not contain any studies with human participants, which were originally performed by any of the authors.

ObjectivesA systematic review to assess the evidence supporting surgical repair of digital nerve injury versus no repair in adults in terms of clinical outcomes.DesignA Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review with methodology based on the Cochrane Handbook of Systematic Reviews of Interventions.Data sourcesDatabases included OvidMEDLINE, EMBASE, AMED, clinicaltrials.gov and the Cochrane Database of Systematic Reviews, searched from inception until 10 November 2018.Eligibility criteriaAdult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded.Data extraction and synthesisStudy data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work. The National Institute of Health quality assessment tool for case series was used to assess risk of bias.ResultsThirty studies were included. One compared surgical repair with non-repair. All studies were case series of between 15 and 110 nerve injuries, with heterogeneous patient, injury and treatment characteristics. Two studies detailed nerve repair without magnification. Static 2-point discrimination (s2PD) was the most commonly reported outcome measure. Return of protective sensation was achieved in most cases in the nerve repair and no nerve repair groups. Repair resulted in better s2PD than no repair, but <25% repaired nerves achieved normal levels. Adverse outcomes were similar between repair and no repair groups.ConclusionsOnly level IV evidence is available to support surgical repair of digital nerves in adults. Return of normal sensibility is uncommon and almost all unrepaired nerves regained protective sensation by 6 months and all patients declined further surgery. There was no difference in adverse outcomes. There is currently a lack of high-quality evidence to support surgical repair of digital nerve injuries in adults and further research is needed.PROSPERO registration numberCRD42017065092.