The effect of injury area on the success of treatment in digital nerve injury

Numan Atilgan

doi:10.2340/jphs.v59.40519

Authors

Numan Atilgan Department of Hand surgery, Private Clinic, Gaziantep, Turkey

DOI:

https://doi.org/10.2340/jphs.v59.40519

Keywords:

Digital nerve injuries, surgical repair techniques, Zone 1 and Zone 2 injuries, direct repair

Abstract

Introduction: The main objective of the current study is to investigate variations in postoperative outcomes that follow digital nerve repair in Zone 1 and Zone 2, respectively. We hope that by carrying out this investigation, we will be able to identify which zone has better sensation recovery and patient-reported outcomes, allowing us to identify the best way of conducting surgery for specific types of injuries.

Materials and methods: A retrospective cohort study was conducted in patients with digital nerve injuries treated in a designated hand surgery clinic between January 2021 and December 2023. The study was guided by ethical consideration, where all participants gave their informed consent. Surgical interventions involved primary repair, autograft/allograft nerve grafting, nonsurgical approaches, as well as conduit repair in which results were determined using objective measures and patient feedback.

Results: Direct repair emerged superior among injuries of Zone 1 and Zone 2 with high success rates and good patient-reported outcomes. In general, injuries in Zone 1 had better sensory recovery than injuries in Zone 2 and this was associated with higher levels of satisfaction. Comparisons using statistical methods confirmed that direct repair outperformed other modalities.

Conclusion: More importantly, the comparison of this study shows that repairs in Zone 1 are more successful than those in Zone 2 revealing direct repair as a superior method for digital nerve injuries. The difference is crucial because it suggests that surgical efficiency may depend on where the injury is. This means that direct repair should be given priority over the two zones, although surgeons will need to watch out for challenges related to Zone 2 injuries and adjust their strategies accordingly to obtain the best patient outcomes possible.

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References

Cheng AS. Use of early tactile stimulation in rehabilitation of digital nerve injuries. Am J Occup Ther. 2000;54:159–165. https://doi.org/10.5014/ajot.54.2.159 DOI: https://doi.org/10.5014/ajot.54.2.159

Fakin RM, Calcagni M, Klein HJ, et al. Long-term clinical outcome after epineural coaptation of digital nerves. J Hand Surg Eur Vol. 2016;41:148–154. https://doi.org/10.1177/1753193415578986 DOI: https://doi.org/10.1177/1753193415578986

Thomas PR, Saunders RJ, Means KR. Comparison of digital nerve sensory recovery after repair using loupe or operating microscope magnification. J Hand Surg Eur Vol. 2015;40:608–613. https://doi.org/10.1177/1753193414556006 DOI: https://doi.org/10.1177/1753193414556006

Dresvyanina EN, Tagandurdyyeva NA, Kodolova-Chukhontseva VV, et al. Structure and properties of composite fibers based on Chitosan and single-walled carbon nanotubes for peripheral nerve regeneration. Polymers (Basel). 2023;15:2860. https://doi.org/10.3390/polym15132860 DOI: https://doi.org/10.3390/polym15132860

Geuna S, Gnavi S, Perroteau I, et al. Tissue engineering and peripheral nerve reconstruction: an overview. Int Rev Neurobiol. 2013;108:35–57. https://doi.org/10.1016/B978-0-12-410499-0.00002-2 DOI: https://doi.org/10.1016/B978-0-12-410499-0.00002-2

Thorsen F, Rosberg HE, Steen Carlsson K, et al. Digital nerve injuries: epidemiology, results, costs, and impact on daily life. J Plast Surg Hand Surg. 2012;46:184–190. https://doi.org/10.3109/2000656X.2012.676554 DOI: https://doi.org/10.3109/2000656X.2012.676554

Mermans JF, Franssen BB, Serroyen J, et al. Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair. Hand (N Y). 2012;7:233–241. https://doi.org/10.1007/s11552-012-9433-1 DOI: https://doi.org/10.1007/s11552-012-9433-1

Kim JS, Bonsu NY, Leland HA, et al. A systematic review of prognostic factors for sensory recovery after digital nerve reconstruction. Ann Plast Surg. 2018;80:S311–S316. https://doi.org/10.1097/SAP.0000000000001440 DOI: https://doi.org/10.1097/SAP.0000000000001440

Loos MS, Freeman BG, Lorenzetti A. Zone of injury: a critical review of the literature. Ann Plast Surg. 2010;65:573–577. https://doi.org/10.1097/SAP.0b013e3181d50e3e DOI: https://doi.org/10.1097/SAP.0b013e3181d50e3e

Kim T, Lohse KR, Mackinnon SE, et al. Patient outcomes after peripheral nerve injury depend on bimanual dexterity and preserved use of the affected hand. Neurorehabil Neural Repair. 2024;38:134–147. https://doi.org/10.1177/15459683241227222 DOI: https://doi.org/10.1177/15459683241227222

Pamuk C. Digital nerve injury: to repair or not? Ir J Med Sci. 2023;192:2235–2241. https://doi.org/10.1007/s11845-022-03268-4 DOI: https://doi.org/10.1007/s11845-022-03268-4

Billig JI, Sears ED, Travis BN, et al. Patient-reported outcomes: understanding surgical efficacy and quality from the patient’s perspective. Ann Surg Oncol. 2020;27:56–64. https://doi.org/10.1245/s10434-019-07748-3 DOI: https://doi.org/10.1245/s10434-019-07748-3

Lans J, Eberlin KR, Evans PJ, et al. A systematic review and meta-analysis of nerve gap repair: comparative effectiveness of Allografts, Autografts, and conduits. Plast Reconstr Surg. 2023;151:814e–827e. https://doi.org/10.1097/PRS.0000000000010088 DOI: https://doi.org/10.1097/PRS.0000000000010088

Contreras E, Traserra S, Bolivar S, et al. Decellularized graft for repairing severe peripheral nerve injuries in sheep. Neurosurgery. 2023;93:1296–1304. https://doi.org/10.1227/neu.0000000000002572 DOI: https://doi.org/10.1227/neu.0000000000002572

Moriya K, Yoshizu T, Tsubokawa N, et al. Outcomes of flexor tendon repairs in Zone 2 subzones with early active mobilization. J Hand Surg Eur Vol. 2017;42:896–902. https://doi.org/10.1177/1753193417715213 DOI: https://doi.org/10.1177/1753193417715213

Kotwal PP, Ansari MT. Zone 2 flexor tendon injuries: venturing into the no man’s land. Indian J Orthop. 2012;46:608–615. https://doi.org/10.4103/0019-5413.104183 DOI: https://doi.org/10.4103/0019-5413.104183

Herman ZJ, Ilyas AM. Sensory outcomes in digital nerve repair techniques: an updated meta-analysis and systematic review. Hand (N Y). 2020;15:157–164. https://doi.org/10.1177/1558944719844346 DOI: https://doi.org/10.1177/1558944719844346

Domeshek LF, Novak CB, Patterson JMM, et al. Nerve transfers-A paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open. 2019;7:e2290. https://doi.org/10.1097/GOX.0000000000002290 DOI: https://doi.org/10.1097/GOX.0000000000002290

Evertsson L, Carlsson C, Turesson C, et al. Incidence, demographics and rehabilitation after digital nerve injury: a population-based study of 1004 adult patients in Sweden. PLoS One. 2023;18:e0283907. https://doi.org/10.1371/journal.pone.0283907 DOI: https://doi.org/10.1371/journal.pone.0283907

Wang E, Inaba K, Byerly S, et al. Optimal timing for repair of peripheral nerve injuries. J Trauma Acute Care Surg. 2017;83:875–881. https://doi.org/10.1097/TA.0000000000001570 DOI: https://doi.org/10.1097/TA.0000000000001570

Tobler-Ammann BC, Beckmann-Fries V, Calcagni M, et al. Outcomes of primary Flexor Tendon repairs in Zones 2 and 3: a retrospective cohort study. J Hand Surg Glob Online. 2023;5:445–453. https://doi.org/10.1016/j.jhsg.2023.03.016 DOI: https://doi.org/10.1016/j.jhsg.2023.03.016

Ross PT, Bibler Zaidi NL. Limited by our limitations. Perspect Med Educ. 2019;8:261–264. https://doi.org/10.1007/s40037-019-00530-x DOI: https://doi.org/10.1007/S40037-019-00530-X