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Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review
Journal article   Open access   Peer reviewed

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

Zachary J. Herman and Asif M. Ilyas
Hand (New York, N.Y.), v 15(2), pp 157-164
01 Mar 2020
DOI: https://doi.org/10.1177/1558944719844346
PMID: 31043071
url
https://doi.org/10.1177/1558944719844346View
Published, Version of Record (VoR)Open Access (License Unspecified),  Open

Abstract

Review
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.

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