Long-term clinical outcome after epineural coaptation of digital nerves

J Hand Surg Eur Vol. 2016 Feb;41(2):148-54. doi: 10.1177/1753193415578986. Epub 2015 Mar 31.

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.

Keywords: Digital nerve repair; neuromas; sensory recovery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Finger Injuries / diagnostic imaging
  • Finger Injuries / surgery*
  • Fingers / diagnostic imaging
  • Fingers / innervation*
  • Fingers / surgery*
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Peripheral Nerve Injuries / diagnostic imaging
  • Peripheral Nerve Injuries / surgery*
  • Postoperative Complications
  • Prognosis
  • Recovery of Function
  • Ultrasonography