title: What is evidence based in the reconstruction of digital nerves? A systematic review.
abstract: 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.
  
  
  METHODS
  Therapeutic II.
authors.affiliation: Erasmus MC, Department of Plastic, Reconstructive and Hand Surgery, Rotterdam, The Netherlands. w.rinkel@erasmusmc.nl
authors.forename: Willem D
authors.initials: WD
authors.lastname: Rinkel
authors.forename: Bionka M A
authors.initials: BM
authors.lastname: Huisstede
authors.forename: Dirk-Jan J C
authors.initials: DJ
authors.lastname: van der Avoort
authors.forename: J Henk
authors.initials: JH
authors.lastname: Coert
authors.forename: Steven E R
authors.initials: SE
authors.lastname: Hovius
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000294:innervation*; D006230:Hand Injuries / Q000175:diagnosis / Q000601:surgery; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D016896:Treatment Outcome