From the Research
Management of a digital nerve laceration or transection to the left second digit requires prompt surgical intervention for optimal outcomes, with microsurgical repair of the nerve being the primary treatment, ideally within 72 hours of injury to prevent retraction of nerve ends and improve functional recovery. The procedure involves careful identification of the proximal and distal nerve stumps, followed by tension-free coaptation using 8-0 or 9-0 nylon sutures under microscopic guidance, as supported by the most recent study 1.
Key Considerations
- The goal of surgical intervention is to improve or restore sensation and decrease the risk of painful traumatic neuroma formation, with studies showing that primary end-to-end repair and reconstruction of digital nerves increase a patient's likelihood of sensation recovery 1.
- The use of a microvascular background material can provide better visualization of the proximal and distal ends while performing the repair, and it is essential to sharply guillotine the ends of the nerve to freshen up the laceration and provide healthy nerve ends for repair 1.
- Post-operatively, the digit should be immobilized for 3-4 weeks using a dorsal splint to protect the repair site, and pain management typically includes acetaminophen and ibuprofen, with stronger options like tramadol if needed for severe pain.
- Sensory re-education therapy should begin 4-6 weeks after repair to improve functional outcomes, involving exercises to retrain sensory perception, and patients should be counseled that nerve regeneration occurs at approximately 1mm per day, and complete recovery may take 6-12 months depending on the location of injury 2.
Outcomes and Prognosis
- Even with optimal repair, some degree of permanent sensory deficit may remain, particularly in adults, with a systematic review showing that the average percentage of patients who had undergone repair and reported a recovery to Highet grade 4 was 24% 1.
- Regular follow-up evaluations at 2 weeks, 6 weeks, 3 months, and 6 months are essential to monitor recovery progress and address any complications, and the choice of repair technique may depend on the gap length and the location of the injury, with autograft and allograft performing comparably and superior to conduit repair in some cases 3.