The gold standard treatment of a complete injury to the sensory nerves to the hand involves a direct end-to-end suture repair using a microscope. This repair with high magnification aims to improve nerve regeneration, restoration of sensation and prevent a neuroma: a hypersensitive nerve. Despite this, most patients never fully recover, and it takes 18-24 months for a recovery deemed “reasonable”. Nerve conduits are established for bridging gaps in nerve repair without the need for a nerve graft. The results of previous studies are encouraging. The addition of a conduit to a microsurgical nerve repair may prevent axonal misdirection or prevent tethering of the repair site in scar tissue. The recent publication of a protocol for a randomised controlled trial to examine the results of nerve conduit augmentation of a microsurgical nerve repair will establish whether there is any benefit of this technique over a traditional repair in digital nerves. However, suture placement at the site of nerve injury may distort the fascicular architecture and result in impaired axonal regeneration, reduced sensoryrecovery and painful neuroma formation at the nerve repair site. The objective of this study is to evaluate the recovery following repair of digital nerves within the hand treated with direct microsurgical suture, suture with nerve conduit augmentation or nerve conduit apposition with remote suture distal to the injury site.
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