Termino-lateral nerve repair involves suturing the distal stump of an injured nerve to the epineurium of an intact donor nerve. The authors report 7 cases of termino-lateral nerve coaptation in the treatment of iatrogenic and traumatic digital nerve injuries and failed synthetic nerve conduits. An additional 17 cases of previously published end-to-side digital nerve repairs were reviewed. Improved sensitivity was recorded in 23 of 24 cases at a minimum follow-up of 6 months: mean 2-point discrimination measured 9.7 mm (range 3-18 mm). However, preoperative 2-point discrimination measurements were not consistently available for comparison.
Several methods have been described for the repair of digital nerve injuries with loss of nerve substance, including nerve autograft, nerve allograft, vein conduits, and synthetic conduits. End-to-side nerve coaptation may be a feasible treatment alternative when other techniques are not possible or are declined by a patient. However, further studies are necessary to determine the safety and efficacy of end-to-side digital nerve repair, with particular emphases on sensitivity improvement and donor nerve morbidity.