Digital Nerve Repair With Flexor Tendon Injury: Conduits are Less Effective

Digital nerve injuries resulting in gaps not amendable to direct coaptation are frequently reconstructed utilizing conduits or processed nerve allograft (PNA). Concurrent flexor tendon repair necessitates the incorporation of a postoperative rehab protocol. The effects of this early mobilization on digital nerve regeneration following PNA or conduit reconstruction are not known.

Patient data collected during the RECON study included static 2-point discrimination (S2PD) and Semmes-Weinstein Monofilament testing following digital nerve reconstruction for gap defects of 5 to 25 mm with either PNA or conduits. Additional data included concurrent procedures such as flexor tendon repair and participation in rehab protocols. Outcomes were compared with respect to concurrent flexor tendon repair across all reconstruction techniques.

A total of 182 enrollees were included in analysis. Of these, 67 patients suffered concomitant flexor tendon and digital nerve injuries. Thirty-five and 32 of these patients received PNA and collagen conduits for their nerve repairs, respectively. For the patients that underwent tendon repair, S2PD was 6.8 mm in the PNA group and 8.1 mm in the conduit group. S3 + or better was achieved following 65.7% of the PNA and 71.9% conduit reconstructions in the flexor tendon repair group. A significantly lower percentage of conduit repairs achieved American Society for Surgery of the Hand classification normal and fair in patients with tendon injuries (50%) versus those without tendon injury (73.3%) (P = .038).

Following digital nerve gap reconstruction in a large multi-center prospective, randomized trial, concurrent flexor tendon repair with early mobilization may have compromised conduit efficacy.

NCT01809002.