Reconstruction of proper digital nerve defects in the thumb using a pedicle nerve graft.

BACKGROUND

Traumatic defects of the proper digital nerve in the thumb affect tactile perception of the thumb pulp. This article reports on the treatment of the defect using a pedicle nerve graft taken from the dorsal branch of the proper digital nerve of the index or long finger, or both.

METHODS

From May of 2006 to March of 2010, the pedicle nerve graft was used in 16 thumbs in 16 patients. There were 13 male and three female patients, with an average age of 33 years. Nerve repair was performed on one side in six thumbs and on both sides in 10 thumbs. The average length of the defects was 2.5 cm, between the middle of the distal phalanx and metacarpophalangeal joint. The average length of the nerve grafts was 2.7 cm. For comparison, we also collected a consecutive series of 27 patients with thumb proper digital nerve defects treated using a nonvascularized graft taken from the sural nerve (n = 15) or the medial antebrachial cutaneous nerve (n = 12).

RESULTS

At a mean follow-up of 22 months, the mean static two-point discrimination and Semmes-Weinstein monofilament scores on the thumb pulps were 6.7 mm and 3.62, respectively. The measurements of patients treated using nonvascularized nerve grafts were 9.4 mm and 3.90, respectively. The outcomes of the two groups were significantly different.

CONCLUSIONS

The pedicle nerve graft is useful and reliable for reconstructing proper digital nerve defects in the thumb. Superior sensory recovery was achieved using vascularized instead of unvascularized nerve grafts.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.