Management of Digital Nerve Injuries: Direct Repair versus Conduit

Abstract

Introduction: Digital nerve injuries impair sensation and fine motor function. This review compares outcomes of direct epineurial repair versus nerve conduits for gaps up to 15 mm.

Methods: A systematic review of clinical studies reporting sensory recovery following digital nerve repair. Inclusion: adults with sharp transection of digital nerves, repaired primarily or with conduit. Outcomes: two-point discrimination, monofilament testing, and patient satisfaction.

Results: Twenty-eight studies (n=955 nerve repairs) were included. Direct repair achieved excellent (≤6 mm 2PD) recovery in 70% of gaps <5 mm. Conduits for gaps 5-15 mm achieved 60-70% excellent recovery, similar to direct repair with tension. For gaps >10 mm, conduits were inferior to nerve grafts (50% versus 75% excellent). Conduit failure occurred in 8% (neuroma or extrusion).

Discussion: Direct repair remains gold standard for tension-free coaptation. Conduits are acceptable alternatives for small gaps but should not exceed 15 mm. Patient age <30 years predicted better outcomes across both techniques.

Conclusions: Direct repair is preferred whenever possible. Conduits are useful for gaps 5-15 mm. Nerve grafts are superior for longer gaps.