Nerve injuries sustained during warfare

Part II: Outcomes

R. Birch, P. Misra, M. P. M. Stewart, W. G. P. Eardley, A. Ramasamy, K. Brown, R. Shenoy, P. Anand, J. Clasper, R. Dunn, J. Etherington

Abstract

The outcomes of 261 nerve injuries in 100 patients were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in 18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)). The initial grades for the 42 sutures and graft were 11 good, 14 fair and 17 poor. After subsequent revision repairs in seven, neurolyses in 11 and free vascularised fasciocutaneous flaps in 11, the final grades were 15 good, 18 fair and nine poor. Pain was relieved in 30 of 36 patients by nerve repair, revision of repair or neurolysis, and flaps when indicated. The difference in outcome between penetrating missile wounds and those caused by explosions was not statistically significant; in the latter group the onset of recovery from focal conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8 months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower limbs) presented with an insensate foot. By final review (mean 27.4 months (20 to 36)) plantar sensation was good in 26 limbs (55%), fair in 16 (34%) and poor in five (11%). Nine patients returned to full military duties, 18 to restricted duties, 30 to sedentary work, and 43 were discharged from military service. Effective rehabilitation must be early, integrated and vigorous. The responsible surgeons must be firmly embedded in the process, at times exerting leadership.

Footnotes

  • The authors wish to thank Dr C. Cordivari (Queens Square) for ensuring the rapid investigations of patients by electrodiagnostic methods. The patients illustrated in Figures 1 and 2 were treated by Mr D. Power, FRCS and Mrs J. Webb, FRCS at the Queen Elizabeth Hospital, Birmingham. The figures are reproduced from Surgical disorders of the peripheral nerves, 2nd edition, 2011, by kind permission of Springer UK.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Received October 19, 2011.
  • Accepted December 1, 2011.
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