Distal sensory neurotization: An alternative to nerve grafting for digital nerve defect

Injuries to the proper digital sensory nerves are common in hand surgery, and repairing them is essential for restoring pulp sensitivity and preventing neuroma formation. When segmental nerve loss exceeds 1 cm, direct repair is rarely feasible and autologous nerve grafting remains the gold standard. However, sensory neurotization involving only one coaptation and surgical site offers a promising alternative. Here, we present the case of a 61-year-old patient who sustained a severe laceration to the volar aspect of the left fifth digit in zone 3. This resulted in segmental loss of the ulnar digital nerve and the overlying soft tissue. Sensory neurotization using the ulnar dorsal sensory branch was performed to reinnervate the distal stump of the ulnar digital nerve. Skin coverage was achieved using a rotation flap based proximally, harvested from the dorsal proximal phalanx of the same digit. The patient experienced satisfactory functional and sensory recovery.