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Connector-assisted repair (CAR) significantly improves nerve regeneration outcomes compared to direct repair (DR), leading to better sensory recovery and reduced cold intolerance in peripheral nerve injuries.

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Area of Science:

  • Neurosurgery
  • Regenerative Medicine
  • Orthopedic Surgery

Background:

  • Peripheral nerve injuries are a significant clinical challenge.
  • Direct repair (DR) and connector-assisted repair (CAR) are surgical techniques used for nerve reconstruction.
  • Understanding the comparative efficacy of these techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze clinical literature comparing outcomes of DR and CAR for peripheral nerve repair.
  • To assess differences in meaningful recovery, neuroma formation, pain, cold intolerance, and revision rates between DR and CAR.

Main Methods:

  • A systematic literature review was conducted for studies published between 1980 and August 2023.
  • Included studies involved upper extremity nerve repairs with gaps < 5mm using DR or CAR.
  • Comparative analyses focused on sensory Medical Research Council Classification (MRCC) outcomes, including meaningful recovery (MR) rates.

Main Results:

  • CAR demonstrated significantly higher MR rates at both MRCC S3 (96.1% vs. 81.3%) and S3+ (87.1% vs. 54.2%) thresholds (P < 0.0001).
  • The incidence of cold intolerance was substantially lower with CAR (10.7%) compared to DR (46.2%).
  • No significant differences were found in neuroma rates or pain scores; altered sensation was not analyzed due to data limitations.

Conclusions:

  • Connector-assisted repair is superior to direct repair for achieving sensory meaningful recovery in peripheral nerve injuries.
  • CAR significantly reduces the likelihood of developing cold intolerance post-surgery.
  • These findings support the use of CAR for improved functional outcomes in nerve repair.