Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2

Impact of single versus dual arterial supply on perfusion and function in finger replantation after complex hand injuries

Finger amputations following complex hand injuries (CHI) pose a significant challenge in hand surgery due to severe tissue trauma and neurovascular damage, necessitating precise arterial repair. While restoring arterial perfusion is critical, it remains unclear whether reconstructing both proper palmar digital arteries is required for optimal outcomes. This study evaluates whether restoring one or both arteries in finger replantation after complex injuries impacts perfusion and overall outcomes. In this retrospective, cross-sectional, follow-up study, we investigated patients with finger amputations following CHI admitted to the high-volume regional hand trauma center between January 2013 and December 2020. Perfusion has been assessed using FLIR thermal imaging and laser speckle contrast analysis. Functional outcomes and quality of life scores were measured using standardized questionnaires. Sensory assessments, along with pain and grip strength measurements were also conducted. A total of 31 patients were included in the study. Thermal imaging showed a significantly higher finger surface temperature in patients with two-artery reconstruction. Laser speckle contrast analysis confirmed better perfusion, though not statistically significant. Functional and quality-of-life scores were similar across groups, except for significantly improved temperature sensation in the two-artery group. In conclusion, reconstructing both arteries in finger replantation following CHI isn't essential for good outcomes if one artery provides adequate perfusion, but dual reconstruction may improve perfusion and temperature sensation.

Comparative Effectiveness Systematic Review and Meta-analysis of Peripheral Nerve Repair Using Direct Repair and Connector-assisted Repair

Background

This clinical literature systematic review and meta-analysis were performed to assess differences in outcomes between nerves repaired with direct repair (DR) and connector-assisted repair (CAR).

Methods

A systematic literature review for DR and CAR was performed. Studies from 1980 through August 2023 were included if DR or CAR repairs were performed in upper extremities with nerve gaps less than 5 mm and reported sensory Medical Research Council Classification (MRCC) outcomes or equivalent. Comparative analyses were planned for meaningful recovery (MR) rate (at both S3 and S3+ or better), postsurgical neuroma, cold intolerance, altered sensation, pain, and revision rate.

Results

There were significant differences in MR rates for CAR and DR. At the MRCC S3 threshold, 96.1% of CAR and 81.3% of DR achieved MR (P < 0.0001). At the MRCC S3+ threshold, 87.1% of CAR and 54.2% of DR achieved this higher threshold of MR (P < 0.0001). There were no differences in neuroma rate or pain scores in our dataset. Altered sensation (dysesthesia, paresthesia, hyperesthesia, or hypersensitivity) was not discussed in any CAR studies, so no analysis could be performed. The revision rate for both procedures was 0%. The proportion of patients with cold intolerance was 46.2% in the DR studies, which was significantly higher than the 10.7% of patients in the CAR group.

Conclusions

Significantly more patients achieved sensory MR and fewer had cold intolerance when the CAR technique, instead of the DR technique, was performed to repair peripheral nerve injuries.

Digital nerve injury: to repair or not?

BACKGROUND

There are very few studies comparing patients with and without repair after digital nerve injury. It is still controversial whether digital nerve repair is necessary.

AIMS

The aim of this study was to evaluate the long-term clinical outcomes of patients with unilateral isolated digital nerve injury who underwent surgical repair and those who did not.

METHODS

Seventy-four patients with unilateral digital nerve injury were included in the study. Of these, the patients who underwent surgical repair were determined as group A (n = 42), the patients without repair as group B (n = 32), and the groups were divided into subgroups according to injury levels. Results were evaluated with a minimum follow-up of 24 months.

RESULTS

When the S2PD results were evaluated overall, it was found that those who had digital nerve repair (group A) had significantly better outcomes compared to those without repair (group B) (p = 0.012). When the subgroups were evaluated according to the injury localization, no significant difference was observed at the distal levels, while it was observed that the patients who underwent repair in the proximal levels showed significantly better results (p = 0.003, p = 0.012).

CONCLUSION

In this study, it was seen that there was no difference between the results of repair and non-repair of unilateral nerve injuries distal to the middle level of the middle phalanx, but repair is required in injuries proximal to this level.

Blood Vessel Injuries of the Fingers: A Clinical Comparison of One- and Two-Arterial Blood Supply

Traumatic finger injuries are very common in emergency medicine. When patients present with finger injuries, there is often damage to the vascular nerve bundles, which requires subsequent reconstruction. It is unknown if repairing a unilaterally injured artery affects patients' recovery in a well-perfused finger. This retrospective cohort study compares the clinical outcomes of 11 patients with one-vessel supply (mean age 48.3 years; 7 males, 4 females) to 14 patients with two-vessel supply (mean age 44.5 years; 8 males, 6 females). The patient outcomes were assessed using patient questionnaires (Disabilities of Arm, Shoulder, and Hand (DASH), European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L), and EuroQol visual analog scale (EQ-VAS)) and a clinical examination of hand function and imaging of circulatory efficiency. No significant changes were observed in the DASH, EQ-5D-5L, and EQ-VAS questionnaires. Clinical evaluation of hand function, measured by cold sensitivity, two-point discrimination, pain numerical analog scale, and grip strength also revealed no significant differences between cohorts. Blood flow measurements using thermal imaging revealed no effects on circulation in the affected digit. Collectively, the study finds reconstruction is not absolutely necessary when there is one intact digital artery as it is sufficient for healing and functional outcomes. We recommend finger artery reconstruction when both digital arteries are injured or if an immediate tension-free suture is possible.

Is microsurgical experience essential in Zone II flexor tendon injuries?

OBJECTIVES

This study aims to investigate whether microsurgical experience was necessary for the treatment of Zone II flexor tendon injuries.

PATIENTS AND METHODS

Between October 2018 and October 2021, a total of 73 Zone II flexor tendon injuries in 71 patients (53 males, 18 females; mean age: 39.6±12.1 years; range, 21 to 57 years) who underwent surgical intervention in our center were retrospectively analyzed. All patients in the study had flexor digitorum profundus (FDP) tendon injury. The clinical outcomes of patients with digital artery injury, nerve injury or phalanx fracture accompanying FDP tendon injury were evaluated separately according to the American Society for Surgery of the Hand (ASSH) scores. The scores of multiple injuries accompanying FDP tendon injury in patients with FDP+flexor digitorum superficialis (FDS)+digital nerve injury and FDP+FDS+digital artery+nerve injury were evaluated.

RESULTS

The mean ASSH score was 69.4±28.2 in the group with FDP tendon injury accompanying digital nerve injury and 62.9±19.7 in the group with FDP tendon injury and digital artery injury. The clinical outcomes were significantly lower in patients with digital nerve injury and digital artery injury respectively, compared to patients without accompanying injuries (p=0.029 and p=0.012, respectively). The lowest mean score (45.3±10.2) was in patients with fracture accompanying FDP tendon injury and ASSH score was significantly lower than in patients without fracture (p<0.001).

CONCLUSION

Zone II flexor tendon injuries are frequently accompanied by digital artery or nerve injuries, which usually require microsurgical repair. If left untreated, treatment outcome may be poor. Surgical centers and departments undertaking the treatment of flexor tendon injuries should be able to perform microsurgery.

Traumatized Hand - Update at the First Visit

The hand is the segment most exposed to trauma, with a large volume of care in urgent and emergency services. Therefore, it is necessary that physicians on duty have the essential knowledge to effectively manage these injuries. In the present article, we will review the main conditions and conduct guidelines.