Trial evidence is mixed regarding digital nerve reconstruction

By medwireNews Reporters

Evidence supporting various surgical and postsurgical interventions in digital nerve reconstruction is inconsistent or imprecise, research shows.

Low-quality evidence was found to support a polyglycolic acid conduit compared with standard therapy in digital nerve gaps less than 4 mm and more than 8 mm during long-term follow up, according to randomized controlled trial (RCT) data.

There is also very-low-quality evidence in favor of use of anesthetic cream (EMLA crème) compared with placebo for short-term but not long-term sensory relearning, and low-quality evidence in favor of sensory reeducation compared with control therapy.

The results are based solely on RCTs, states Willem Rinkel (University Medical Center, Rotterdam, the Netherlands) and colleagues in the Journal of Plastic, Reconstructive and Aesthetic Surgery.

"The evaluation of digital nerve repair as described in most observational studies is scored very good or excellent while using different modes of two-point discrimination," according to the researchers.

The lack of solid evidence in RCTs in hand surgery is not surprising, they add. Often studied in multicenter settings, each center constructs only a small number of nerves in new ways, with operators on the steep part of the learning curve.

Eight RCTs were included in the analysis, including five surgical interventions and three postsurgical interventions.

Compared with gold-standard therapy, which is end-to-end neurorrhaphy or autologous nerve grafting, the evidence supporting a polyglycolic acid conduit was low quality and rated as inconsistent or imprecise by the researchers.

Static and moving two-point discrimination (S2PD and M2PD) testing revealed that the polyglycolic acid tubing was superior to the gold standard when closing nerve gaps no more than 4 mm and 8 mm or larger.

There was also low-quality evidence supporting sensory recovery with the conduit compared with end-to-end neurorrhaphy and no significant differences at 12 months when comparing the procedure against vein grafting for S2PD, M2PD, time of repair, cost of repair, or complication rates.

The evidence supporting short-term use of the EMLA crème was classified as imprecise or inconsistent.

One RCT supported the benefit of sensory reeducation versus a control group, with documented improvements in S2PD, M2PD, and sensory return at 6 months.

The researchers note that there is room for improvement with regard to reporting study design, outcome measures, dropout rates, follow up, side effects, and complications, among others.

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