scholarly journals Comments on “Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-Analysis and Systematic Review”

Hand ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. 884-885
Author(s):  
James J. Drinane ◽  
Darren E. Gemoets ◽  
Malcolm Z. Roth
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Nerve Repair ◽  
Digital Nerve ◽  
Repair Techniques

scholarly journals Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review

Hand ◽  
2019 ◽  
Vol 15 (2) ◽  
pp. 157-164
Author(s):  
Zachary J. Herman ◽  
Asif M. Ilyas
Keyword(s):  
Systematic Review ◽  
Nerve Injury ◽  
Surgical Management ◽  
Meta Analysis ◽  
Nerve Repair ◽  
Complication Rates ◽  
Digital Nerve ◽  
Exclusion Criteria ◽  
Conduit Repair ◽  
Repair Techniques

Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.

scholarly journals Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Felix J. Paprottka ◽  
Petra Wolf ◽  
Yves Harder ◽  
Yasmin Kern ◽  
Philipp M. Paprottka ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Nerve Repair ◽  
Donor Site ◽  
Surgical Techniques ◽  
Graft Material ◽  
Digital Nerve ◽  
Nerve Reconstruction ◽  
Level Of Evidence ◽  
Sensory Recovery ◽  
End To End

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.

Comparison of nerve conduits and nerve graft in digital nerve regeneration: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jefferson Braga Silva ◽  
Bruna Leiria Meréje Leal ◽  
Gabriela Agne Magnus ◽  
Valentina de Souza Stanham ◽  
Rita Mattiello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nerve Regeneration ◽  
Meta Analysis ◽  
Nerve Graft ◽  
Digital Nerve ◽  
Nerve Conduits

scholarly journals Outcome of surgical repair of adult digital nerve injury: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025443 ◽  
Author(s):  
Rebecca L E Dunlop ◽  
Justin Conrad Rosen Wormald ◽  
Abhilash Jain
Keyword(s):  
Systematic Review ◽  
Nerve Injury ◽  
Systematic Reviews ◽  
Outcome Measure ◽  
Surgical Repair ◽  
Nerve Repair ◽  
Case Series ◽  
Adverse Outcomes ◽  
Digital Nerve ◽  
Protective Sensation

ObjectivesA systematic review to assess the evidence supporting surgical repair of digital nerve injury versus no repair in adults in terms of clinical outcomes.DesignA Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review with methodology based on the Cochrane Handbook of Systematic Reviews of Interventions.Data sourcesDatabases included OvidMEDLINE, EMBASE, AMED, clinicaltrials.gov and the Cochrane Database of Systematic Reviews, searched from inception until 10 November 2018.Eligibility criteriaAdult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded.Data extraction and synthesisStudy data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work. The National Institute of Health quality assessment tool for case series was used to assess risk of bias.ResultsThirty studies were included. One compared surgical repair with non-repair. All studies were case series of between 15 and 110 nerve injuries, with heterogeneous patient, injury and treatment characteristics. Two studies detailed nerve repair without magnification. Static 2-point discrimination (s2PD) was the most commonly reported outcome measure. Return of protective sensation was achieved in most cases in the nerve repair and no nerve repair groups. Repair resulted in better s2PD than no repair, but <25% repaired nerves achieved normal levels. Adverse outcomes were similar between repair and no repair groups.ConclusionsOnly level IV evidence is available to support surgical repair of digital nerves in adults. Return of normal sensibility is uncommon and almost all unrepaired nerves regained protective sensation by 6 months and all patients declined further surgery. There was no difference in adverse outcomes. There is currently a lack of high-quality evidence to support surgical repair of digital nerve injuries in adults and further research is needed.PROSPERO registration numberCRD42017065092.

Outcomes of Tibial Nerve Repair and Transfer: A Structured Evidence-Based Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Stuti P. Garg ◽  
Abbas M. Hassan ◽  
Anooj A. Patel ◽  
Megan M. Perez ◽  
Jenna R. Stoehr ◽  
...  
Keyword(s):  
Systematic Review ◽  
Tibial Nerve ◽  
Meta Analysis ◽  
Nerve Repair ◽  
Evidence Based

scholarly journals Treatment of Ulnar Collateral Ligament Tears of the Elbow

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668221 ◽  
Author(s):  
Brandon J. Erickson ◽  
Bernard R. Bach ◽  
Nikhil N. Verma ◽  
Charles A. Bush-Joseph ◽  
Anthony A. Romeo
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Return To Sport ◽  
Ulnar Collateral Ligament ◽  
Treatment Method ◽  
Gap Formation ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Internal Bracing ◽  
Repair Techniques

Background: Ulnar collateral ligament (UCL) tears have become common, and UCL reconstruction (UCLR) is currently the preferred surgical treatment method for treating UCL tears. Purpose/Hypothesis: The purpose of this study was to review the literature surrounding UCL repair and determine the viability of new repair techniques for treatment of UCL tears. We hypothesized that UCL repair techniques will provide comparable results to UCLR for treatment of UCL tears. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Biomechanical and clinical outcome investigations reporting on UCL repair with levels of evidence 1 through 4 were eligible for inclusion. Descriptive statistics were calculated for each study and parameter/variable analyzed. Results: Of the 46 studies eligible, 4 studies (3 clinical and 1 biomechanical) were included. There were 92 patients (n = 92 elbows; 61 males [62.3%]; mean age, 21.9 ± 4.7 years) included in the clinical studies, with a mean follow-up of 49 ± 14.4 months. Eighty-six percent of repairs performed were on the dominant elbow, and 38% were in college athletes. Most UCL repairs (66.3%) were performed via suture anchors. After UCL repair, 87.0% of patients were able to return to sport. Overall, 94.9% of patients scored excellent/good on the Andrews-Carson score. Patients who were able to return to sport after UCL repair did so within 6 months after surgery. Biomechanically, when UCL repair was compared with the modified Jobe technique, the repair group showed significantly less gap formation than the reconstruction group. Conclusion: In patients for whom repair is properly indicated, UCL repair provides similar return-to-sport rates and clinical outcomes with shorter return-to-sport timing after repair compared with UCL reconstruction. Future outcome studies evaluating UCL repair with internal bracing are necessary before recommending this technique.

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