What is evidence based in the reconstruction of digital nerves? A systematic review

Background: An intact digital nerve is obligatory for hand function. When transected, the hand surgeon has several options. However, there is no hard evidence which technique to choose.

Objective: The aim of this study was to provide an evidence-based overview of the effectiveness of interventions used in reconstruction and post-surgical management of digital nerve injuries.

Methods: The Cochrane Library, PubMed, EMBASE, CINAHL and PEDro databases were searched. Two reviewers independently applied the inclusion criteria to select potential relevant randomised controlled trials (RCTs) and controlled clinical trials (CCTs), extracted data and performed a methodological quality assessment of the included studies. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method was used to summarise the results.

Results: Eight RCTs were included, five on surgical and three on post-surgical interventions. Low-quality evidence was found for effectiveness in favour of a polyglycolic acid conduit compared to primary neurrorhaphy or autologous graft, in digital nerve gaps of ≤4 mm and ≥8 mm at long-term follow-up. Very low quality of evidence was found for effectiveness in favour of EMLA crème, compared to placebo, in enhancing sensory relearning for the short-term, but not for the long-term outcomes. Low quality of evidence was found for effectiveness in favour of sensory re-education compared with control at long-term follow-up. For other interventions, no evidence for effectiveness was found.

Conclusions: Indications for effectiveness of some treatment strategies in digital nerve repair were found, but due to a minimal number of RCTs in this field no firm conclusions could be drawn for the different techniques. More high-quality RCTs are needed for a more confident estimate of effect.

Level of evidence: Therapeutic II.