Delayed Suture of Sensory Nerves of the Hand

Shaffer, James M.; Cleveland, Frank

doi:10.1097/00006534-195009000-00020

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“…Hyperaesthesia or unpleasant sensory disturbance had a high incidence in two studies of repaired nerves, with 67% and 40% patients affected for up to 2 years 30 31. Three other nerve repair papers give an incidence of unpleasant sensory disturbance of 8%, 12% and 1% 3 32. Chronic regional pain syndrome was also mentioned following nerve repair 33…”

Section: Resultsmentioning

confidence: 98%

“…The age of the patient was a significant predictive factor for s2PD outcome following nerve repair in 14 studies 4 26 27 32 38–47. Although this systematic review evaluated adult digital nerve injury, it was apparent from the literature that children got much better results than adults 48.…”

Section: Discussionmentioning

confidence: 97%

“…Ten of these studies included children (age <18) and a further six may have done. Younger age is associated with better outcomes and therefore it is possible that the ‘excellent’ results seen in some studies was influenced by patient age 4 26 27 32 38–47. It is therefore clear that despite surgical repair, very few patients actually achieve ‘normal’ preinjury levels of sensation and in fact the data may be skewed in favour of a better outcome due to younger patients being included in studies.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of surgical repair of adult digital nerve injury: a systematic review

2019

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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.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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