The proper palmar digital nerves are the terminal sensory branches of the common palmar digital nerves (from the median and ulnar nerves), running on the medial and lateral aspects of each finger in the neurovascular bundles to supply the finger pulp, the nail bed, and the dorsal distal phalanx skin (via dorsal digital branches from the proper digital nerves distally). Each finger has a radial and ulnar proper palmar digital nerve of approximately 1-2 mm diameter.
Proper digital nerve repair after sharp laceration is the most common peripheral nerve microsurgery. The nerve runs slightly dorsal to the digital artery in the neurovascular bundle (remembering 'Never Argue About Anything' — Nerve Above Artery, Artery Above Anything, mnemonic for dorsal-to-palmar order: NVB dorsal-to-palmar = nerve, artery, flexor sheath). Primary repair with 8-0 nylon epineurial sutures within 72 hours of injury provides optimal sensory recovery. Neuroma in continuity at the digital nerve repair site may require secondary neurolysis if hypersensitivity persists. Two-point discrimination testing assesses proper digital nerve function and repair quality.
Glass or blade laceration to the finger divides the proper palmar digital nerve, producing sensory loss to the half of the finger supplied; primary microsurgical epineurial repair within 72 hours with 8-0 monofilament nylon sutures under loupe magnification provides the best chance of sensory recovery with two-point discrimination returning to less than 6 mm in 70% of primary repairs.
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