gms | German Medical Science

Objectives/Interrogation: In this case, we demonstrated the effectiveness of allograft in repairing traumatic digital nerve injuries distal to the trifurcation.

We also show the utility of dermal skin substitutes in reconstruction following complex hand injuries.

These techniques allow for a greater range of options for hand surgeons offering reduced morbidity for patients with traumatic injuries.

Methods: A 17-year-old male presented with full thickness open wounds to the left index and long digits along the radial contact surfaces of the left index and long digits. Portions of the radial digital nerve were missing on both the index and long fingers with gaps of 2.2 cm and 1.6 cm respectively. The gap in the index finger was distal to the trifurcation, and the long finger was at the trifurcation. The index and long digits had skin loss of 3 x 1.8 cm and 3.2 x 1.6 cm, respectively, on the volar radial aspect of both digits.

1-2mm diameter allografts were selected to match the native nerve. The allograft was positioned between ends of the nerve segments followed by a nerve connector over each anastomosis.

Considering the distal nature of the nerve repair in the index digit, we chose to connect the nerve allograft to multiple small nerve ends.

Due to multiple digits involved and difficulty gaining distal coverage of the fingers, we elected to place dermal substitute. We placed bilayer meshed integra directly over the nerve repair and wound for the soft tissue coverage.

Six months after follow up, the patient reported improvements in strength and return of full range of motion. The patient reported normal sensation, and Semmes-Weinstein sensory mapping correlated with these results.

Results and Conclusions: Nerve allograft placement is a viable alternative in cases of traumatic injury to digital nerves as it mitigates the unorganized distribution of nerve fibers found in nerve conduits as well as donor site morbidities found with autografts.

We used a dermal substitute to cover and protect the underlying subdermal structures including the nerve allograft. The porosity of this material allows it to better approximate the physiological function of the skin originally covering the wound, resulting in a more complete return to normal functionality as well as superior aesthetic outcomes. This case indicates that dermal skin substitute can be used as an alternative to autograft and skin flaps for increased functionality and reduced donor site morbidity.