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Outcomes of Digital Nerve Reconstruction Using Posterior Interosseous Nerve Autografts
Brian Rinker, MD; Ryan Wilson, MD
University of Kentucky, Lexington, KY

Introduction: Nerve autografts are considered the "gold standard" for reconstructing digital nerve injuries with segmental loss, but are associated with donor site morbidity. The terminal branch of the posterior interosseous nerve (PIN) is easy to harvest, is usually of sufficient caliber for digital nerve reconstruction, and its harvest yields no known donor deficit. Despite this, the PIN is not routinely used as a source of autograft, and there is minimal outcome data in the literature.

Materials & Methods: A retrospective review was conducted of all patients who underwent reconstruction of a digital nerve gap with a PIN autograft by a single surgeon between 2004 and 2014. Demographics, medical history, location and mechanism of injury, interval between injury and repair, concomitant injuries, gap length were recorded. Clinic and therapy charts were accessed to obtain sensory recovery data and identify complications. Recovery was graded according to the Medical Research Council Classification for sensory function, with meaningful recovery defined as ? S3. Outcomes were compared to historical data for autograft reconstructions using other donor nerves.

Results: 37 digital nerve repairs in 34 subjects were included. In 5 additional patients the PIN was deemed of insufficient caliber. There were 28 males and 6 females (mean 35). Two patients gave a prior history of diabetes, and there were 13 smokers. The most commonly reported mechanisms of injury were saw injuries (n=10), glass lacerations (n=7), and knife injuries (n=5). The average gap length was 10.7 3.1 mm (range 5-18 mm). Objective outcomes data were recorded for 22 patients at three months postop, and for 17 patients at 6 months. Recovery to the ? S3 level was reported in 88% of repairs at 6 months. Mean s2PD was 10.1 3.3 mm at 3 months, and 8.1 2.7 mm at 6 months. Mean m2PD was 9.1 3.9 mm at 3 months, and 7.8 3.1 mm at 6 months. These data compared favorably to historical data for nerve autograft repairs, with reported levels of meaningful recovery of 60-88%. Two patients had delayed healing, and three patients had mild local cellulitis. No patient required reoperation or readmission.

Conclusions: The caliber of the PIN varies, but it was sufficient for use in 87% of patients. The PIN is a suitable donor for digital nerve reconstruction in gaps up to 18 mm, and high rates of meaningful recovery can be achieved, without significant donor sensory loss.

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