Digital Nerve Coaptation vs Standard of Care for Partial and Ray Digital Amputations

Traction neurectomy (TN) remains the standard of care for digital nerve management in partial and ray digital amputations but is associated with both neuroma formation and chronic postoperative pain. The purpose of this study is to evaluate if digital nerve coaptation (DNC) is associated with lower postoperative pain and complication rates compared to standard TN. We hypothesize that patients undergoing digital amputations with DNC will demonstrate lower postoperative complications, reduced rates of persistent pain, and fewer reoperations for nerve-related pain.

A retrospective cohort study was conducted, analyzing 95 patients who underwent partial or ray amputation at a single institution from 2019 to 2024. Patients were stratified by nerve management technique: DNC (n = 26) vs TN (n = 69). Primary outcomes included postoperative pain scores and complication rates including neuroma formation, infection, wound dehiscence, persistent pain, and functional stiffness. Pain scores were assessed using the Neuropathic Pain Scale (NPS, 0-100) and a numerical pain rating scale (NPRS, 0-10). Of the 95 patients, 48 (TN = 33, DNC = 15) were successfully contacted for postoperative pain assessment. Statistical comparisons were made using independent t tests, Mann-Whitney U tests, and chi-square analyses, with significance set at P  < 0.05.

Patients with a digit amputation that underwent DNC experienced a lower percentage of complications compared to traction neurectomy (26.9% vs 55.1%, P  = 0.030). Furthermore, although not statistically significant, patients undergoing DNC reported lower average NPS (36.1 vs 43.8, P  = 0.263) and NPRS (3.79 vs 4.20, P  = 0.590) scores compared to neurectomy alone. This trend of decreased pain scores reported by patients who received DNC was true regardless of whether the amputation was due to acute injury or other causes. Similarly, patients described reduced pain at all amputation levels except the middle phalanx.

These data indicate a positive observable outcome when comparing patients' postoperative pain and rate of complications with DNC vs TN at the time of amputation. Though a larger sample size is needed to solidify these results, these findings do suggest that DNC is a potentially superior alternative for nerve management in digital amputations, with the potential to improve long-term pain control and patient outcomes.