Digital nerve repair is a microsurgical procedure that is performed to help treat severed or damaged nerves. This is done by reconnecting the damaged ends of a nerve in the hand or finger so as to regain sensation.
Nerves are the wiring system that carry the signals between the brain and the body. Digital nerves are the nerves in the digits or fingers. They have an outer covering that is called the epineurium or nerve sheath. The work of the nerve sheath is to surround and protect the nerve fibers or fascicles. The nerve fibers carry the signals between the brain and the fingers. The transmitted signals may be to inform the brain of various sensations such as pain, texture, and other sensations. However, the transmission of the signals can be halted when one of the nerves is severed due to injuries like deep lacerations in the hand or fingers.
In many cases the wound is stitched up in the hope that the severed nerves will grow back together. In some cases, however, the nerves fail to heal up correctly or the nerves are too severed to heal. In such a case, nerve repair surgery can be brought up as an option after the injury has healed but there is still persistent pain.
Digital Nerve Repair Procedure
Digital nerve repair surgery is usually done under local anesthesia. The hand is cleansed and correctly placed for easier access by the surgeon. An incision is then made in the area of the severed nerves. An operative microscope will be used to view the nerve endings. The surgeon trims the nerves in order to reveal the healthy tissue.
There are three techniques that may be used in digital nerve repair depending on the extent of the nerve damage, and they include:
- Repairing with sutures: This involves the surgeon sewing together the healthy ends of the nerve sheath with fine sutures without creating tension. If the severed nerve is the one with the sensory and motor function the surgeon may group and sew the nerve fibers together.
- Repairing with nerve conduit: The surgeon may use a nerve conduit if too much tension may be created by using suture alone. The conduit can be a graft from the patient’s own vein, or a tube made from silicone. The conduit is placed between the sheath ends with the surgeon attaching it with fine sutures. The conduit serves as an extension of the nerve sheath and guides the nerve fiber ends together so they can rejoin.
- Repairing with nerve graft: If the larger nerves have been severed and created a gap, the surgeon may close the gap using a nerve graft. The graft is usually harvested from another area of the patient’s body such as from a section of larger sensory nerves from the back of the leg. The corresponding ends of the severed nerve fibers in the hand are connected to the ends of the nerve fibers in the cable graft by sewing them together with fine sutures.
Bandages are then used to close the skin and the finger is placed into a splint.
Recovery After Digital Nerve Repair
The recovery period after digital nerve repair varies as nerves often take much longer time to heal compared to muscle or skin. It can take 3-4 weeks for the nerves to begin to heal. As the nerves begin to grow back together, it can be painful, and most patients experience pins and needles, but it is a good sign which shows that the surgery has been successful. Physical therapy is usually prescribed during the recovery to help prevent stiffness or other issues.
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