NEON is a multicentre, double-blind RCT asking whether microsurgical suture repair of a lacerated digital nerve beats simply aligning the nerve ends without suturing. It enrolled adults with an isolated, single unilateral digital nerve injury amenable to tension-free repair. The primary outcome was the hand-nerve-specific I-HaND PROM at 12 months.
When you explore a clean, isolated digital nerve laceration, the best current evidence says formal microsurgical suture repair adds little over carefully aligning the nerve ends. The I-HaND trend actually favored alignment alone, and every functional and quality-of-life measure was equivalent at one year.
The one signal for repair was slightly better static two-point discrimination, but on 23 patients and with no effect on how the hand actually works. The critical caveat is power: the funder closed the trial at 122 of a planned 478 patients, so P = 0.09 is a failure to prove superiority, not proof of true equivalence.
Just as important, alignment alone is not the same as no operation. Exploring the wound, debriding, and aligning the nerve ends may still matter, since misdirected reinnervation causes permanent loss.
NEON is a multicentre, double-blind RCT asking whether microsurgical suture repair of a lacerated digital nerve beats simply aligning the nerve ends without suturing. It enrolled adults with an isolated, single unilateral digital nerve injury amenable to tension-free repair. The primary outcome was the hand-nerve-specific I-HaND PROM at 12 months.
When you explore a clean, isolated digital nerve laceration, the best current evidence says formal microsurgical suture repair adds little over carefully aligning the nerve ends. The I-HaND trend actually favored alignment alone, and every functional and quality-of-life measure was equivalent at one year.
The one signal for repair was slightly better static two-point discrimination, but on 23 patients and with no effect on how the hand actually works. The critical caveat is power: the funder closed the trial at 122 of a planned 478 patients, so P = 0.09 is a failure to prove superiority, not proof of true equivalence.
Just as important, alignment alone is not the same as no operation. Exploring the wound, debriding, and aligning the nerve ends may still matter, since misdirected reinnervation causes permanent loss.