{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:10:03Z","timestamp":1790097003196,"version":"4.0.1"},"update-to":[{"DOI":"10.12688\/f1000research.169801.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000}},{"DOI":"10.12688\/f1000research.169801.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000}},{"DOI":"10.12688\/f1000research.169801.3","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000}}],"reference-count":65,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background Sensory recovery following digital nerve neurorrhaphy is often incomplete, and strategies to enhance regeneration remain under investigation. Low-frequency transcutaneous electrical stimulation has been proposed as a potential adjunctive therapy, but its efficacy in clinical settings is uncertain. Methods In this randomized controlled trial, 32 patients with isolated traumatic digital nerve injuries underwent surgical neurorrhaphy at a tertiary care hospital. Participants were randomly allocated to an intervention group (n = 16) or sham group (n = 16). The intervention consisted of a single postoperative session of square-pulsed, biphasic transcutaneous electrical stimulation at 20 Hz for 1 hour. The sham group received identical conditions without active stimulation. After stimulation, patients underwent physiotherapy sessions for three months. Sensory recovery was assessed using Semmes-Weinstein monofilament testing and two-point discrimination at baseline, 1 week, 1 month, and 3 months postoperatively. Results Both groups showed progressive sensory improvement throughout follow-up, approaching normal values at 3 months. No statistically significant differences were observed between groups in any outcome measure. Confidence intervals for group comparisons overlapped, and no clinically meaningful differences were detected. No adverse effects were reported. Conclusions In this model, a single postoperative session of low-frequency transcutaneous electrical stimulation did not significantly enhance sensory recovery after digital nerve repair. Further research with varied stimulation protocols, repeated sessions, or extended follow-up may be warranted to clarify its potential role in peripheral nerve regeneration. Level of Evidence Therapeutic Level I.<\/ns3:p>","DOI":"10.12688\/f1000research.169801.4","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:44:06Z","timestamp":1790095446000},"page":"1222","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of transcutaneous electrical stimulation on peripheral nerve regeneration after digital neurorrhaphy: A randomized clinical trial."],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2039-9744","authenticated-orcid":false,"given":"Enilton de Santana Ribeiro de","family":"Mattos","sequence":"first","affiliation":[{"name":"Orthopedics and Traumatology Research Group Salvador Bahia 40110-100 Federal University of Bahia (UFBA)"},{"name":"Faculty of Medicine of Bahia Salvador Bahia 40026-010 Federal University of Bahia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7013-7107","authenticated-orcid":false,"given":"Alex","family":"Guedes","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Research Group Salvador Bahia 40110-100 Federal University of Bahia (UFBA)"},{"name":"Faculty of Medicine of Bahia Salvador Bahia 40026-010 Federal University of Bahia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yossi","family":"Zana","sequence":"additional","affiliation":[{"name":"Graduate Program of Neuroscience S\u00e3o Bernardo do Campo S\u00e3o Paulo 09606-045 Federal University of ABC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Itamar Ferraz","family":"Lessa","sequence":"additional","affiliation":[{"name":"Salvador State of Bahia 41150-000 Bahia State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1701-5279","authenticated-orcid":false,"given":"C\u00e9sar Romero","family":"Antunes J\u00fanior","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Research Group Salvador Bahia 40110-100 Federal University of Bahia (UFBA)"},{"name":"Faculty of Medicine of Bahia Salvador Bahia 40026-010 Federal University of Bahia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4688-8857","authenticated-orcid":false,"given":"Eduardo Silva Reis","family":"Barreto","sequence":"additional","affiliation":[{"name":"Orthopedics and Traumatology Research Group Salvador Bahia 40110-100 Federal University of Bahia (UFBA)"},{"name":"Faculty of Medicine of Bahia Salvador Bahia 40026-010 Federal University of Bahia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7870-3820","authenticated-orcid":false,"given":"Abrah\u00e3o Fontes","family":"Baptista","sequence":"additional","affiliation":[{"name":"Laboratory of Functional Neuromodulation and Pain Rio de Janeiro Rio de Janeiro 21941-853 Federal University of Rio de Janeiro (UFRJ)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0146193","DOI":"10.1371\/journal.pone.0146193","article-title":"Biomechanical Characteristics of Hand Coordination in Grasping Activities of Daily Living.","volume":"11","author":"M Liu","year":"2016","journal-title":"PLoS One."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e025443","DOI":"10.1136\/bmjopen-2018-025443","article-title":"Outcome of surgical repair of adult digital nerve injury: a systematic review.","volume":"9","author":"R Dunlop","year":"2019","journal-title":"BMJ Open."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"313-325","DOI":"10.1111\/j.1750-3639.1999.tb00229.x","article-title":"Nerve Injury, Axonal Degeneration and Neural Regeneration: Basic Insights.","volume":"9","author":"G Stoll","year":"1999","journal-title":"Brain Pathol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"535-543","DOI":"10.1053\/jhsu.2000.6458","article-title":"A model instrument for the documentation of outcome after nerve repair.","volume":"25","author":"B Ros\u00e9n","year":"2000","journal-title":"J. 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We agree that the anatomical targeting of the stimulation protocol required further clarification. The Methods section has been revised to specify that electrode placement was individualized according to the injured digit and surgical repair site, with electrodes positioned proximal and distal to the neurorrhaphy along the presumed course of the repaired digital nerve. We also clarified that the median nerve motor threshold was used only as an operational reference to standardize stimulation intensity, not as the anatomical target of stimulation. To avoid overstatement, we now acknowledge that selective and equivalent recruitment of the repaired digital nerve branch across all digits cannot be fully confirmed. We also agree that null findings are better interpreted through the magnitude of between-group differences and precision rather than p-values alone. Accordingly, we revised the Results section to include numerical between-group estimates in the original clinical units. Specifically, we added the unadjusted mean differences and 95% confidence intervals for SWM, s2PD, CSS, and PDI at the 3-month assessment. We chose this format rather than standardized effect sizes because mean differences in grams, millimeters, and questionnaire points are more directly interpretable in a clinical trial context. These estimates did not indicate a clear advantage of PES over sham. Finally, we revised the Discussion and Study limitations sections to address the sensitivity of the outcome measures. We now clarify that, although SWM and s2PD are clinically established tools after digital nerve repair, they may not detect subtle treatment-related differences in axonal regeneration, receptor reinnervation, or sensory processing. We also emphasize that this limitation, together with the possible ceiling effect by three months, should be considered when interpreting the null findings.","URL":"https:\/\/f1000research.com\/articles\/14-1222\/v4#referee-comment-16056","order":1,"name":"referee-comment-16056","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.200497.r483123, Johannes Heinzel, Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Baden-Wuerttemberg, 14 May 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/14-1222\/v3#referee-response-483123","order":2,"name":"referee-response-483123","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.200497.r486394, Christoph A Schroen, Icahn School of Medicine at Mount Sinai, New York, New York, 09 Jun 2026, version 3, indexed","URL":"https:\/\/f1000research.com\/articles\/14-1222\/v3#referee-response-486394","order":3,"name":"referee-response-486394","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Eduardo Silva Reis Barreto<\/b>; \n<i>Posted: 16 Jun 2026<\/i>; Review report: \u201cEffects of transcutaneous electrical stimulation on peripheral nerve regeneration after digital neurorrhaphy: A randomized clinical trial\u201d.  June 15, 2026  \n<i>Dear Editor and Reviewers,<\/i>  \n<i>Thank you for your valuable feedback, which has greatly improved the quality and clarity of our manuscript. We have made the requested changes and are available for any further revisions. Below are our responses to the reviewers' comments:<\/i>   \n<b>#Reviewer 3:<\/b> Thank you for the opportunity to review this manuscript. This study presents a well-conducted and highly relevant randomized clinical trial investigating whether a single 1-hour postoperative session of transcutaneous electrical nerve stimulation following digital nerve neurorrhaphy may improve sensory recovery compared to a sham group. Both groups improved significantly at 3 months, although no differences between groups were observed in any outcome measure. The authors conclude that this protocol of transcutaneous nerve stimulation may thus not enhance sensory recovery after digital nerve repair.  I believe this study addresses a timely and important research question, and the methodology used in this study is appropriate for answering this question. Nonetheless, I believe a few suggestions and considerations should be addressed:  (1) The placement of both electrodes may warrant additional discussion. The nerve injuries in this study are very distal, and Wallerian degeneration may extend further proximally than the position of the proximal electrode. If true, this would mean that a more proximal electrode may have been more efficacious at improving nerve recovery. The overall great outcomes at 3 months in both groups suggest that Wallerian degeneration remained limited to an area close to the repair site, but additional considerations regarding electrode placement may improve the discussion of this study.  (2) In the results section, the authors mention that no signification between group differences were observed, but they do not present the specific p-values. Instead, they state &quot;p &gt; 0.05&quot;. Please add the exact p-values for between-group comparisons at all three time points to the results section.  (3) In this study, both groups demonstrate overall great outcomes at three months postoperatively. In previous studies, electrical stimulation has been shown to accelerate functional recovery and improve outcomes after peripheral nerve injury. The authors are appropriately cautious when interpreting the results from this study and provide a thoughtful discussion including potential reasons for the discordance between their findings and previous literature. Nonetheless, as both groups recovered significantly, these results can be explained by a ceiling effect, which should be addressed in the limitations section as a limitation in patient selection and study design.  (4) If possible, please discuss briefly whether electrical stimulation may be more helpful for motor recovery or sensory recovery or similarly beneficial, including potential reasons.  (5) In Figure 3, the labels should explicitly state whether data is from the treatment or sham group instead of only stating &quot;A&quot; or &quot;B&quot;. Please make it more obvious which dataset belongs to which group.  Addressing the points above may improve the interpretability of these findings. Overall, this is a well-conducted study that adds meaningfully to the literature.  \n<b>Author response and action taken: <\/b>\n<i>We thank the reviewer for the careful evaluation of our manuscript and for the constructive comments. Below, we address each point and summarize the changes made in the revised version.<\/i>  \n<i>We agree with the reviewer that electrode placement is an important aspect of the stimulation protocol. We added a paragraph to the Discussion addressing the possibility that the local transcutaneous montage around the neurorrhaphy may not have optimally recruited the relevant proximal axonal segment or produced sufficient current density across the repair zone. We also discuss that electrode position and field geometry should be considered active components of dose delivery rather than merely technical details.<\/i> \n<i>The Results section was revised to include the exact p-values for between-group comparisons and for the repeated-measures ANOVA group and group-by-time effects.<\/i> \n<i>We agree that the favorable recovery observed in both groups may have reduced the ability to detect an additive effect of PES. We revised the Study limitations section to explicitly state that selecting isolated distal digital nerve injuries may have introduced a ceiling effect due to the short regeneration distance and the absence of a motor component.<\/i> \n<i>A new paragraph was added to the Discussion to address differences between motor, mixed, and purely sensory nerve injury models and their implications for detecting the effects of electrical stimulation.<\/i> \n<i>Figure 3 and its legend were revised to clarify which data correspond to the PES group and the sham group.<\/i>","URL":"https:\/\/f1000research.com\/articles\/14-1222\/v4#referee-comment-16439","order":4,"name":"referee-comment-16439","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}