Microsurgical Techniques for Digital Nerve Injuries and Vascular Injuries

Area of Science:

• Orthopedics
• Neurosurgery
• Hand Surgery

Background:

• Digital nerve and vascular injuries often result from traumatic wounds, necessitating surgical exploration and repair.
• Surgical options include tension-free end-to-end repair or reconstruction using sutures, nerve "glues" (fibrin-based gels), or nerve wraps/conduits.
• For nerve gaps, nerve allografts and autografts are superior to conduit reconstruction.

Purpose of the Study:

• To outline surgical techniques for digital nerve and vascular repair.
• To emphasize the goals of improved sensation and reduced neuroma formation.
• To discuss alternatives and expected outcomes of digital nerve reconstruction.

Main Methods:

• Surgical exploration and identification of neurovascular bundles.
• Sharp incision of traumatized nerve/artery ends to facilitate repair.
• Mobilization of structures, measurement of defects, and primary repair or reconstruction using magnification and fine sutures (8-0 or 9-0).
• Application of nerve conduits or wraps with fibrin glue if needed.

Main Results:

• Primary repair and reconstruction increase the likelihood of sensation recovery and digit preservation.
• Nerve "glues" reduce initial gapping and increase tensile strength when used with wraps.
• Nerve allografts and autografts yield similar results for nerve gaps.

Conclusions:

• Surgical repair of digital nerves enhances the probability of sensation recovery, though complete recovery is not guaranteed.
• Arterial repair is crucial for digit preservation in cases of vascular injury.
• Key considerations include careful technique, appropriate material selection, and understanding the potential outcomes and risks.