Observation of the therapeutic effect and analysis of risk factors in the acute repair of traumatic digital nerve injury.

PURPOSE: To investigate differences in clinical efficacy and prognostic factors among surgical techniques for traumatic digital nerve complete transection injuries, thereby providing scientific evidence for clinical treatment selection.

METHODS

A retrospective analysis was conducted on patients with traumatic digital nerve complete transection injuries treated surgically at the Department of Burn and Plastic Surgery, Second Affiliated Hospital of Air Force Military Medical University from January 2017 to December 2022. Patients were divided into epineurial suture group and perineurial suture group based on repair techniques. Clinical outcomes were evaluated using the modified British medical research council scale (BMRCs), Semmes-Weinstein monofilament test (G1-G5), the trial standards for evaluation of partial function of the upper extremity of the Chinese society for surgery of the hand of the Chinese Medical Association, and self-completed Douleur Neuropathique 4. Patients were stratified by BMRCs (≥S3: good sensory recovery; < S3: poor sensory recovery), and by S-DN4 (≥3: neuropathic pain positive; <3: neuropathic pain negative). Univariate and multivariate logistic regression analyses were performed to identify factors affecting sensory recovery and neuropathic pain development. Group comparisons were conducted using rank-sum tests, χ2 or Fisher's exact tests.Multivariate logistic regression was used to identify prognostic factors, reporting odds ratios and 95% confidence intervals. All statistical tests were p < 0.05 considered statistically significant.

RESULTS

A total of 152 patients were included (88 in epineurial suture group; 64 in perineurial suture group). The cohort comprised 127 males and 25 females, with a mean age of (35.2 ± 12.4) years and mean body mass index of (23.13 ± 3.64) kg/m2. The median hospitalization duration was 4.99 (3.90, 6.77) days, and the median follow-up time was 45.1 (27.0, 62.0) months. Baseline characteristics showed no significant differences between groups (p > 0.050). The perineurial suture group demonstrated significantly better nerve function recovery (p = 0.007); however, the operating time was longer than the epineurial group (p < 0.001). Multivariate logistic regression identified smoking (OR = 4.727, 95%CI = 1.650 - 13.545, p = 0.004) and diabetes (OR = 4.928, 95%CI = 1.020 - 23.810, p = 0.047) as risk factors for poor sensory recovery. Surgical technique was also significantly associated with sensory recovery outcomes (OR = 0.179, 95%CI = 0.050 - 0.635, p = 0.008). Regarding neuropathic pain, smoking was identified as a risk factor (OR = 4.238, 95%CI = 1.428 - 12.575, p = 0.009), and concomitant vascular injury was also identified as a risk factor (OR = 3.242, 95%CI = 1.090 - 9.644, p = 0.034).

CONCLUSION

This study demonstrates that perineurial suture technique achieves superior sensory recovery outcomes compared to epineurial suture, despite longer operating times. Furthermore, smoking status, diabetes, and concomitant vascular injury may be primary risk factors affecting digital nerve prognosis.