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Sensory Recovery Following Digital Nerve Repair Using Conduits Versus Autologous Nerve Grafts: A Systematic Review

Ahmed M Omran¹, Atef A Hassan², Sherif Hamdeno¹

¹Plastic Surgery Department, Al-Azhar University, Damietta, Egypt.

|January 21, 2026

Abstract

Background:

Peripheral nerve injuries (PNI), particularly digital nerve injuries, can lead to significant loss of function, pain, and sensory deficits. Autologous nerve grafting (ANG) has been the gold standard for nerve gap reconstruction, but it is associated with donor site morbidity and other complications. Nerve conduits, including collagen-based, chitosan-based, and muscle-in-vein conduits, have emerged as potential alternatives with the advantage of avoiding donor site morbidity. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of nerve conduits versus autologous nerve grafts for digital nerve repair, with a particular focus on sensory recovery.

Methods:

A systematic review and meta-analysis were performed following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies comparing nerve conduits to ANG for the treatment of digital nerve injuries were identified through comprehensive database searches up to July 2025 on PubMed, Scopus, Embase, and Web of Science. Primary outcomes included static and moving two-point discrimination (S2PD and M2PD). Secondary outcomes included the safety profile. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model.

Results:

A total of five studies with a total number of 214 patients were included in the analysis. Nerve conduits showed comparable sensory recovery to ANG for both S2PD (MD = -0.21; 95% CI -2.25 to 1.83; p = 0.84) and M2PD (MD = -0.67; 95% CI -2.00 to 0.66; p = 0.84). Subgroup analysis indicated that chitosan-based conduits demonstrated significantly better outcomes than ANG for S2PD (MD = -2.57; 95% CI -3.40 to -1.74; p < 0.0001); however, overall pooled results across all conduit types showed comparable sensory recovery to ANG. Complication rates were comparable between the two treatments (RR = 2.36; 95% CI 0.90 to 6.22; p = 0.08), with low heterogeneity across studies (I² = 0%). Pooled results from RCTs showed a lower rate of complications with the conduit compared to ANG, RR = 3.32 (95% CI: 1.15 to 9.64; p = 0.03), with no heterogeneity (I² = 0%).

Conclusions:

Nerve conduits, particularly chitosan-based, collagen-based, and muscle-in-vein conduits, provide comparable sensory recovery to ANG without donor site morbidity, representing a viable alternative for digital nerve repair.

Keywords:

autologous nerve grafting chitosan‐based conduits collagen‐based conduits digital nerve repair muscle‐in‐vein conduitnerve conduitsperipheral nerve injury

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