Retrospective Study of Surgical Repair of Gunshot Injuries of Peripheral Nerves.

Abstract

Background: Shotgun injuries of the peripheral nerves are presented frequently during the last decades at the Service of Neurosurgery of UHC “Mother Theresa” in Tirana. In such cases the surgical repair of brachial plexus and peripheral nerves constitutes a challenge with relation to difficulties related with mechanism of injury, coexistence of other vascular damage, bone, soft tissue and visceral lesions.
 Materials and methods: A retrospective study of operated cases with shotgun injuries treated in our Department from 1997 to 2012 was conducted getting information from clinical charts, surgical registries, intraoperative photos and videos of the surgical repair of peripheral nerves. We performed a thorough analysis of the most influencing factors of surgical outcome such as: age, severity of injury, site of injury with relation to the innervated muscles, type of necessary nerve repair, presence of causalgia before operation, concomitant compromise of vascularization and/or locomotor apparatus. Follow-up of the patient was conducted through out-patient visits and phone interviews going back 10 years from surgical repair.
 Results: 68 cases operated for shotgun injury of brachial plexus or peripheral nerves were revised. There were different ages and both sexes involved. The type of nerve repair went from interfascicular neurolysis to direct end-to-end microsuture and nerve grafting. Timely repair of the nerve injury proved to be yielding better result than late repair in terms of pain relief and sensory motor improvement of the preoperative neurological deficit. The degree and the quality of improvement after surgery is related to the type of repair (neurolysis improves better and faster than grafting), the distance from site of injury to the effector muscle (the longer the distance more time it takes for the function to recover). The recovery of the brachial plexus was followed up for many years and further surgery proved to be necessary and of further improvement.
 Conclusions: From our long term experience dealing with surgical repair of shotgun injury of peripheral nerves we have learnt that early surgical repair is more efficacious in treating pain and gives better results in terms of motor and sensitive recovery than six months after injury as it was usually done. Long term follow-up is necessary to help with further surgery in case of distal decompressive surgery in anatomical tunnels.

Timing of surgical intervention in peripheral nerve injuries from gunshot wounds: Management and review of the literature

“…[4] In a 68-case retrospective study by Alimehmeti et al on the surgical repair of GSW PNIs ranging from interfascicular neurolysis to direct end-to-end microsuture, they determined that early surgical repair of GSW PNIs resulted in improved pain relief and sensory motor improvements. [1] Another study by Pannell et al focused on patients with clinical palsy after GSW to the upper extremity and found that due to the high incidence of traumatic nerve laceration, which requires surgical repair after a GSW, it is best to perform early nerve exploration in these patients. [6] In addition, the risk of patients progressing to narcotic dependence for pain management may be reduced through timely intervention.…”

Management of War Limb Injuries in the 21st Century

“…Primary repair of these injuries is contraindicated because it is impossible to determine the exact proximal and distal extent of nerve injury. Recent research suggests that early surgical repair, though, appears to have superior results compared to repair several months after nerve injury in terms of pain treatment and in improving motoric and sensitivity, [33] with consensus for repair being set within 6 months, after injury [32]. Long term follow-up is of utmost importance in order to evaluate the need for further surgical procedures, for example in case of distal decompressive surgery in anatomical tunnels [33].…”