The first ever trial of microsurgical suture repair versus nerve alignment for digital nerve injuries suggests suture repair does not improve outcomes.
Digital nerve injuries are the most common type of nerve injury treated surgically in the UK, often caused by sharp cuts to the fingers.
Around 3,000 digital nerve repairs are performed annually across England and Wales with the aim of retaining the feeling in the fingers. Until now, the assumption has been that delicate microsurgical repair offers patients the best chance of recovery.
The NEON (Nerve rEpair Or Not) Trial, a multicentre randomised controlled trial across 17 NHS hospitals, compared outcomes between patients treated with traditional microsurgical suture repair and those who had their nerve ends carefully aligned without stitches. Despite being closed early by the funder, it is the largest study of its kind in this common injury.
The trial, managed by the Oxford Surgical Intervention Trials Unit (SITU) and the Oxford Clinical Trials Research Unit (OCTRU) and supported by the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre, recruited 122 patients and followed them for 12 months after surgery.
Published in the surgical journal BJS, the study showed no significant difference in patient-reported hand function between the two groups, and no differences in secondary outcomes, including complications, quality of life or need for further treatment.
There was a small improvement in one sensory test (two-point discrimination) for repaired nerves, but this did not translate into better overall hand function.
Justin Wormald, NIHR Academic Clinical Lecturer and co-investigator at the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, said: “The NEON trial provides the best evidence to date on managing digital nerve injuries. We found that carefully aligning the nerve ends gives results in equivalent outcomes when compared to microsurgical repair.
“This means we can be more evidence-based when discussing treatment options for digital nerve injuries with patients, supporting patient care and the wider healthcare system.”
The findings could have important implications for patient care and NHS resources. Avoiding microsurgical repair where it does not offer additional benefit could reduce operating time, free up surgical resources, and potentially lower the risk of complications.