Does reconstructing superficial branch of radial nerve defect with a split homolateral graft prevent painful neuromas?

OBJECTIVE: This study aimed to assess the efficiency of reconstructing the superficial branch of the radial nerve using a split homolateral graft to prevent painful neuromas. METHODS: From January 2019 to October 2022, 32 patients (32 forearms) with traumatic defects of the superficial branch of the radial nerve were treated using a split homolateral graft. The assessments included pain, two-point discrimination, and patient satisfaction. For comparison, another 35 patients (35 forearms) who did not undergo nerve repair were reviewed. RESULTS: The mean age of the nerve repair group was 36 years (range, 18-52 years). The mean defect length was 42 ± 18 mm. The mean follow-up period was 28.5 ± 4.7 months. The mean age of the non-nerve repair group was 35 years (range, 19-54 years). The mean defect length was 45 ± 22 mm. The mean follow-up period was 27.7 ± 5.8 months. There were no significant differences in patient age (P > 0.05), defect length (P > 0.05), and follow-up period (P > 0.05). At the final follow-up, the pain scales at the injury site for the two groups were 0 ± 1 cm vs 5 ± 4 cm (P < 0.05) based on the 10-cm visual analog scale. Sensation on the dorsum of the thumb were 4.8 ± 1.5 mm for the injured hand, 4.2 ± 1.4 mm for the opposite hand, and 9.3 ± 1.6 for the non-nerve repair hand (P < 0.05). Sensation on the first web were 5.2 ± 1.5 mm for the injured hand, 4.7 ± 1.2 mm for the opposite hand, and 8.9 ± 2.6 mm for the non-verve repair hand, (P < 0.05). Based on the Short Assessment of Patient Satisfaction, patient satisfaction of the nerve repair group and non-nerve repair group were 22.3 ± 3.5 and 18.6 ± 4.7, respectively (P < 0.05). CONCLUSIONS: Traumatic defects of the superficial branch of the radial nerve can be reconstructed using a split homolateral graft. Most sensations can be restored without causing morbidity. The surgery may reduce the incidence of painful neuroma formation. LEVEL OF EVIDENCE: Therapeutic study, Level IVa.