Kang Daihun
Ann Plast Surg. 2025 Jun 1;94(6):663-669. doi: 10.1097/SAP.0000000000004242. Epub 2025 Jan 27.
Digital nerve injuries significantly affect hand function and quality of life, necessitating effective reconstruction strategies. Autologous nerve grafting remains the gold standard due to its superior biocompatibility, despite recent advancements in nerve conduits and allogenic grafts. This study aims to propose a novel zone-based strategy for donor nerve selection to improve outcomes in digital nerve reconstruction.
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, searching PubMed, Embase, Cochrane Library, and Web of Science for articles published from January 2004 to December 2023. Inclusion criteria included studies involving adult human subjects undergoing autologous nerve grafting for digital nerve reconstruction, with sensory recovery and donor site morbidity as primary outcome measures. Additionally, an anatomical study comparing donor nerves to digital nerves was included.
Five studies met the inclusion criteria: 4 clinical studies and 1 anatomical study. Analysis of the 4 included clinical studies showed that the posterior interosseous nerve had the lowest donor site morbidity (6.25%), while the lateral antebrachial cutaneous nerve (LABCN) demonstrated the best sensory recovery outcomes (mean 2-point discrimination of 5.92 mm, with 100% of patients achieving good to excellent recovery). The sural nerve exhibited acceptable donor site morbidity (15%) but showed the lowest sensory recovery outcomes (mean 2-point discrimination of 10.8 mm, with only 46% of patients reporting good to very good recovery). The anatomical study indicated that the LABCN had the closest match in cross-sectional area and fascicle count to most zones of the digital nerve, supporting its suitability as a graft source.
Although there are many nerve reconstruction techniques available, autologous nerve grafting remains the gold standard. Based on the analysis of five studies, this review proposes a new zone-based approach for donor nerve selection, emphasizing matching donor nerves to specific injury zones. This tailored strategy can potentially optimize both functional recovery and donor site morbidity, moving beyond the one-size-fits-all paradigm. The posterior interosseous nerve, LABCN, and SN each provide unique benefits depending on the zone of injury, suggesting that this approach may lead to improved patient outcomes. Future research is needed to validate this framework.
指神经损伤会显著影响手部功能和生活质量，因此需要有效的重建策略。尽管神经导管和同种异体移植物最近有了进展，但自体神经移植因其卓越的生物相容性仍然是金标准。本研究旨在提出一种基于区域的新型供体神经选择策略，以改善指神经重建的效果。
按照系统评价和Meta分析的首选报告项目指南进行系统评价，在PubMed、Embase、Cochrane图书馆和Web of Science中检索2004年1月至2023年12月发表的文章。纳入标准包括涉及接受自体神经移植进行指神经重建的成年人类受试者的研究，以感觉恢复和供体部位发病率作为主要结局指标。此外，还纳入了一项将供体神经与指神经进行比较的解剖学研究。
五项研究符合纳入标准：4项临床研究和1项解剖学研究。对4项纳入的临床研究分析表明，骨间后神经的供体部位发病率最低（6.25%），而前臂外侧皮神经（LABCN）的感觉恢复效果最佳（平均两点辨别觉为5.92mm，100%的患者恢复良好至优秀）。腓肠神经的供体部位发病率可接受（15%），但感觉恢复效果最差（平均两点辨别觉为10.8mm，只有46%的患者报告恢复良好至极好）。解剖学研究表明，LABCN在横截面积和束状计数方面与指神经的大多数区域最匹配，支持其作为移植来源的适用性。
尽管有许多神经重建技术可用，但自体神经移植仍然是金标准。基于对五项研究的分析，本综述提出了一种基于区域的新型供体神经选择方法，强调将供体神经与特定损伤区域相匹配。这种量身定制的策略有可能优化功能恢复和供体部位发病率，超越一刀切的模式。骨间后神经、LABCN和腓肠神经根据损伤区域各有独特优势，表明这种方法可能会改善患者的治疗效果。未来需要进一步研究来验证这一框架。
