First multicenter RCT comparing PGA conduit (Neurotube) to standard repair for digital nerve lacerations. The study asks whether conduit repair offers sensory advantages over primary repair or nerve graft, and whether gap length changes the answer. 98 patients with 136 nerve transections were enrolled; blinded 2-point discrimination was measured at 3, 6, 9, and 12 months.
The reflex to close a digital nerve primarily under slight tension — because the gap looks small. Is exactly what this trial challenges.
When you measure a digital nerve gap of 4 mm or less intraoperatively, use a conduit rather than primary repair. The 91% vs. 49% excellent-result rate shows that even imperceptible tension is enough to blunt regeneration. The conduit enforces a minimum 5 mm interstump gap by design.
For gaps of 8 mm or greater, a conduit not only matches a sural nerve graft. It beats it on mean moving 2PD (6.8 mm vs. 12.9 mm) and spares every patient the guaranteed lateral foot numbness that accompanies sural harvest.
The 5–7 mm zone remains unsettled: the conduit arm in that subgroup was overloaded with crush injuries, which independently worsen 2PD, making the comparison unreliable. When the mechanism is a clean laceration, conduit is reasonable across all gap lengths up to 3 cm.
First multicenter RCT comparing PGA conduit (Neurotube) to standard repair for digital nerve lacerations. The study asks whether conduit repair offers sensory advantages over primary repair or nerve graft, and whether gap length changes the answer. 98 patients with 136 nerve transections were enrolled; blinded 2-point discrimination was measured at 3, 6, 9, and 12 months.
The reflex to close a digital nerve primarily under slight tension — because the gap looks small. Is exactly what this trial challenges.
When you measure a digital nerve gap of 4 mm or less intraoperatively, use a conduit rather than primary repair. The 91% vs. 49% excellent-result rate shows that even imperceptible tension is enough to blunt regeneration. The conduit enforces a minimum 5 mm interstump gap by design.
For gaps of 8 mm or greater, a conduit not only matches a sural nerve graft. It beats it on mean moving 2PD (6.8 mm vs. 12.9 mm) and spares every patient the guaranteed lateral foot numbness that accompanies sural harvest.
The 5–7 mm zone remains unsettled: the conduit arm in that subgroup was overloaded with crush injuries, which independently worsen 2PD, making the comparison unreliable. When the mechanism is a clean laceration, conduit is reasonable across all gap lengths up to 3 cm.