gms | German Medical Science

Objectives/Interrogation: We treated two patients with old digital nerve injury complaining persistant pain in fingers by dissection of the injured part and artificial nerve graft. The artificial nerve is consisted of atelocollagen gel core and polylactic acid (PLLA) shell. In both patients, the same postoperative course were recognized and reported in this article although they are short-term results.

Methods: Case 1: 52-year-old woman. She got a small cut wound on the radial side of the medial segment of the left index finger while cutting a tin plate. Although the wound was sutured at nearby clinic, persintant pain and numbness remained more than 6 months. Surgery was performed 8 months after injury. The injured part of the radial digital nerve was covered with scar tissue. When the part was dissected, it became a nerve deficit of 10 mm. The defect was reconstructed with a 10cm length, 1.5 mm diameter artificial bridge nerve graft.

Case 2: 65-year-old man. He cut the palmar side of the right index finger at the PIP joint level with a kitchen knife. Persistant pain and numbness remained in the ulnar side of the finger. Surgery was performed 9 months after injury. The injured ulnar digital nerve was completely torn and there was formation of a stump neuroma on the proximal side. The neuroma was dissected and the difect was reconstructed with 20 mm length, 1.5 mm diameter artificial nerve graft.

Postoperative immobilization with a cast was performed for 2 weeks followed by an automatic exercise in both patients.

Results and Conclusions: In case 1, pain and numbness of the left index finger completely disappeared immediately after the operation. However, numbness appeared again at 3 weeks after surgery and Tinel sign was recognized at distal level of the grafted artificial nerve. Nine months after surgery, she was satisfied with the result of no pain but had weak numbness that was gradually improving. The touch sensation by Semmes-Weinstein (S-W) test was normal.

In case 2, pain and numbness of the right index finger also disappeared immediately after surgery. However, numbness and Tinel sign was recognized 5 weeks after surgery. Eight months after the operation, he was satisfied with no pain although slight numbness still remained. The result of S-W test was diminished light touch.

We concluded artificial nerve graft is effective for pain relief for the patients of old digital nerve injury. However slight numbness will remain in a short-term.