Long-term clinical outcome after epineural coaptation of digital nerves

Abstract

This study evaluates the long-term clinical outcome and complication rate after digital nerve repair in adults and aims to identify possible prognostic factors of sensory recovery. End-to-end epineural coaptation was performed under magnification. A total of 93 coapted digital nerves were clinically evaluated with a mean follow-up of 3.5 years (range 1-6 years). The mean two-point discrimination was 10.6 mm (versus 4.4 mm for the contralateral side). Cutaneous pressure threshold tested with Semmes-Weinstein monofilaments showed a mean value of 2.7 (versus 2.2 for the contralateral side). Only 2% of our patients developed painful neuromas. None of our patients recovered normal functional sensibility, however, recovery of protective sensation contributed to a high reported level of satisfaction. No correlation was observed between the sensory outcome and age, smoking, mechanism of injury, lesion to or anastomosis of a digital artery, or time of immobilization. The only identified predictor of the result was the surgeon's level of experience. This highlights the importance of adequate training and practice in the surgical repair of smaller peripheral nerves. Level of evidence: IV

Replantation by palmar arteriovenous anastomosis in complex finger amputations

“…However, in our experience, the mechanism of injury did not prove to be a valuable predictor of long-term sensory recovery. This finding is consistent with other reports of limited correlation between type of trauma, age group and sensory recovery [14]. Some authors emphasized the importance of the anastomosis of the digital artery to achieve optimal nerve recovery [15,16].…”

“…Thus, arteriovenous anastomosis is unlikely to result in inferior sensory recovery of the replanted digit. Indeed, the results of sensory regeneration in this series are comparable to the long-term clinical outcome of patients after the epineural coaptation of digital nerves, in which none of the patients recovered normal functional sensitivity again [9,14]. This series is limited and therefore our findings about cold intolerance are inconclusive.…”

“…Some authors emphasized the importance of the anastomosis of the digital artery to achieve optimal nerve recovery [15,16]. These findings were challenged in recent trials that failed to demonstrate the significance of arterial reconstruction in enhancing blood perfusion in the injured nerve [12][13][14]. In the presence of an intact contralateral artery, anastomosis of the damaged one is rarely included in standard surgical protocols [14].…”

Evaluation of Cutaneous Spatial Resolution and Pressure Threshold Secondary to Digital Nerve Repair

“…24,25 Because the hand is a complex organ, the function of which depends on the coherence of sensory and motor modalities, traumatic sensory nerve transections frequently impair this functional interaction, with potentially long-lasting sequelae. Our study did not aim at an evaluation of the clinical long-term outcome and its potentially influencing factors after digital nerve repair as presented by Fakin et al 1 Rather, the main focus of our study was the correlative contraposition of sensory tests, which purport measuring similar or equal sensory qualities (spatial discrimination/cutaneous pressure threshold). In addition, some of the applied test instruments have not been described in this distinct context before.…”

“…Assessment of sensory recovery after digital nerve transection thereby plays a major role and has thus been addressed by numerous studies in recent decades. [1][2][3][4][5][6][7][8][9][10] To date, a plethora of test instruments is available to expediently evaluate sensory recovery after transection of nerves. 11 Regrettably, all of these are associated with different drawbacks.…”