INTRODUCTION: Injuries to the proper palmar digital neurovascular bundles are common surgical emergencies in hand trauma. While nerve repair is known to improve sensory recovery, the benefit of associated digital artery repair remains debated when digital vascularization is preserved.
METHODS: We conducted a retrospective comparative single-centre study including patients treated at a European Federation of Hand Emergency Centre for a unilateral injury of the proper palmar digital neurovascular bundle, with a minimum follow-up of 1 year. All patients underwent digital nerve repair with or without arterial repair. Digital artery patency was assessed at follow-up using Doppler ultrasonography combined with superb microvascular imaging. Patients were divided into two groups: patent digital artery (P) and non-patent digital artery (NP). The outcome measures were static two-point discrimination (s2PD), the British Medical Research Council (BMRC) sensory recovery score and cold intolerance.
RESULTS: Eighty-nine unilateral injuries were analysed: 58 in the P group and 31 in the NP group. No statistically significant differences were found between the groups in the median s2PD values (p = 0.49) or BMRC scores combining S3+ and S4 categories (p = 0.87). Perilesional arterial collateralization was significantly greater in the NP group (74.2%) than in the P group (43.1%) (p = 0.003). Cold intolerance symptoms were observed in 32 patients in the P group and 18 patients in the NP group.
CONCLUSION: Digital artery patency does not significantly influence sensory recovery after unilateral injury to the proper palmar digital neurovascular bundle. A richer perilesional arterial collateral network may compensate for the absence of arterial patency and help maintain a vascular environment favourable for nerve regeneration.
LEVEL OF EVIDENCE: III.
Read the article: PubMed · Publisher (DOI)