AFTERTREATMENT

After 3 weeks, the finger joints are allowed gradual active extension beyond the optimal
position noted at surgery. If the defect in the nerve is large, active extension cannot be
permitted before 4 weeks, and a proximal interphalangeal joint flexion contracture is likely
to result. In this circumstance, it is best to perform a nerve graft and allow early digital
motion. Immediate flexion exercises may be allowed within an extension block splint that
prevents tension on the repair site. Although the suture line must be protected, active finger
motion must be started as soon as possible to avoid stiffness and neural adhesions. Yu et
al. compared clinical results in patients with digital nerve repairs who were immobilized for
3 weeks with patients who had associated flexor tendon injuries and were allowed early
protected motion. The difference in sensibility recovery was not statistically significant.

While major nerves are regenerating after repair, the hand may assume an unnatural
posture because of changes in muscle balance. Even when the nerve lesion is proximal to
the wrist, the hand suffers most and may incur fixed contractures before nerve function
returns. Proper splinting (see Chapter 61) is necessary to prevent contractures during this
period. The patient should be warned that until sensation returns, the anesthetic skin can
become infected after even minor trauma or can be burned, frostbitten, cut, or blistered by
friction unless properly protected. The patient should be instructed to inspect the
insensitive areas routinely and to avoid friction and extremes of heat and cold.