title: Long-term clinical outcome after epineural coaptation of digital nerves.
abstract: This study evaluates the long-term clinical outcome and complication rate after digital nerve repair in adults and aims to identify possible prognostic factors of sensory recovery. End-to-end epineural coaptation was performed under magnification. A total of 93 coapted digital nerves were clinically evaluated with a mean follow-up of 3.5 years (range 1-6 years). The mean two-point discrimination was 10.6 mm (versus 4.4 mm for the contralateral side). Cutaneous pressure threshold tested with Semmes-Weinstein monofilaments showed a mean value of 2.7 (versus 2.2 for the contralateral side). Only 2% of our patients developed painful neuromas. None of our patients recovered normal functional sensibility, however, recovery of protective sensation contributed to a high reported level of satisfaction. No correlation was observed between the sensory outcome and age, smoking, mechanism of injury, lesion to or anastomosis of a digital artery, or time of immobilization. The only identified predictor of the result was the surgeon's level of experience. This highlights the importance of adequate training and practice in the surgical repair of smaller peripheral nerves.
  
  
  METHODS
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authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: R M
authors.initials: RM
authors.lastname: Fakin
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Calcagni
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: H J
authors.initials: HJ
authors.lastname: Klein
authors.affiliation: Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland pietro.giovanoli@usz.ch.
authors.forename: P
authors.initials: P
authors.lastname: Giovanoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005385:Fingers / Q000000981:diagnostic imaging / Q000294:innervation* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D020127:Recovery of Function; D014463:Ultrasonography
keywords: Digital nerve repair; neuromas; sensory recovery