Outcomes of Tension-Free Epineural Repair in Digital Nerve Injuries

Abstract

Purpose: Digital nerve injuries can lead to sensory loss, pain, cold intolerance, and reduced quality of life. This study evaluates the outcomes of primary tension-free end-to-end repair under a microscope and the factors affecting these results. Methods: A retrospective review of 27 fingers from 23 patients treated between January 2022 and May 2024 was evaluated. Epineural repair was performed using 8:0 or 9:0 polypropylene sutures. Sensory recovery was assessed with two-point discrimination (2-PDT) and the Semmes-Weinstein Monofilament Test (SWMT). Cold intolerance and patient satisfaction were recorded. Results: Of the patients, 43.5% (n=10) were female, with a mean age of 39.3 years (range: 15-56), and the mean follow-up duration was 21.1 months (range: 6-31). The mean 2-PDT was 8.89 ± 3.9 mm (range: 4-20), with excellent and good sensory recovery observed in 92.6% of cases. The mean SWMT was 3.49 ± 0.6 (range: 2.44-5.07), and only 3.7% of patients exhibited loss of protective sensation. Cold intolerance was present in 48.1% of cases. Patient satisfaction scores averaged 7.8 ± 1.3 (range: 5-10) on a 10-point scale. The presence of flexor tendon or digital artery injuries and cold intolerance was significantly associated with lower satisfaction scores (p < 0.05) Conclusion: Primary epineural repair under a microscope is effective in restoring sensory function following digital nerve injuries and contributes to high patient satisfaction. However, coexisting injuries and cold intolerance negatively impact outcomes. Further studies with larger cohorts are needed.

Keywords

• Digital nerve injury
• digital nerve repair
• sensory recovery
• cold intolerance
• patient satisfaction.

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