NEON - digital NErve, suture Or Not
Research type
Research Study
Full title
A randomised controlled trial assessing if microsurgical nerve repair offers clinical benefit and cost effectiveness (in terms of patient–reported hand function, sensory recovery and adverse events) over exploration and washout without microsurgical nerve repair in adult patients with recent traumatic digital nerve injury.
IRAS ID
258872
Contact name
Abhilash Jain
Contact email
Sponsor organisation
University of Oxford Clinical Trials and Research Governance
ISRCTN Number
ISRCTN16211574
Duration of Study in the UK
5 years, 1 months, 30 days
Research summary
Research Summary: Digital nerves are small nerves that pass along the side of each finger and provide sensation to the fingertips. These nerves can be accidentally cut when handling sharp objects like a knife or broken glass. The NEON study aims to find out whether sewing the ends of the cut nerve surgically is beneficial or even needed. Thoroughly cleaning the cut wound before closing the skin is a much simpler procedure, and may be satisfactory for patients.\n\nThere is some evidence that both treatments give good results. There is also some evidence that patients may not fully recover the feeling in their injured finger, even after the nerve has been sutured. Research so far has been conflicting and is of varying quality. For example, some studies do not directly compare treatments, or do not ask patients about their views of recovery.\n\nThe best way to find out if stitching the cut digital nerve is appropriate is to conduct a research study. NEON will compare surgical procedures for digital nerve repair, with or without stitches (also known as sutures). 478 patients with a single digital nerve injury will have one of these two treatment options by random allocation. \n\nPatients will complete questionnaires measuring fingertip sensation, quality of life and health resource use up to 12 months after the operation. They will also attend clinic visits at 3 and 12 months. Longer term follow up (12-24 months after randomisation) to determine re-operation rates will be collected using routine hospital data.
Summary of Results:
What was the study about? Digital nerves run along the sides of each finger and provide feeling to the fingertips. These nerves are often cut with sharp objects. The NEON (digital NErve, suture Or Not) study compared two ways of treating this type of injury. One method used microsurgical stitches to join the cut nerve ends (suture repair), while the other simply aligned the nerve ends carefully without stitching (nerve alignment alone).Why was this study needed? Suturing the nerve is a common and time-consuming operation, but it was unclear whether it actually improves recovery compared with simply cleaning the wound and aligning the nerve ends. As thousands of such repairs are done each year, reliable evidence is important to guide future care.
How was the study carried out? The NEON study was a randomised controlled trial — the gold standard for comparing treatments — run across NHS hospitals in the UK. Adults with a single cut finger nerve were randomly assigned during surgery to receive either microsurgical suture repair or nerve alignment alone. Everyone received the same wound care and follow-up. Recovery was measured using patient questionnaires about hand feeling and function (the I-HaND scale) and clinical tests of sensation over 12 months.
Who took part? 122 adults took part between 2020 and 2023 across 17 hospitals. The aim had been to recruit 478 patients, but the study was affected by the COVID-19 pandemic, slow site openings, and some surgeons’ uncertainty about the research question. As a result, recruitment stopped early at the request of the funder.
What did the study find? After one year, there was no meaningful difference in recovery between the two groups. Patients who had nerve alignment alone did just as well as those who had stitched repair in terms of feeling, function, and quality of life. Complications, including pain, stiffness, or nerve lumps (neuromas), were similar in both groups.
What does this mean? Based on the available data, there is no evidence that sewing the nerve ends together leads to better recovery than simply aligning them. This suggests that in some cases, a simpler procedure without stitches may be a suitable alternative. However, because the study was smaller than planned, these results should be interpreted with care.
Why is this important? Although smaller than intended, the NEON study is the first and largest randomised study of digital nerve repair versus non-repair. It provides valuable new information about how patients recover after these injuries and shows that both patients and clinicians are willing to take part in this kind of research. The findings will help inform future, larger studies and guide discussions between patients and surgeons about the best treatment options.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
20/SC/0018
Date of REC Opinion
20 Jan 2020
REC opinion
Favourable Opinion