Evidence-Based Approach to Timing of Nerve Surgery

Cox, Cameron; Valerio, Ian L.; Greenberg, Jeffrey A.; Buncke, Gregory M.; Evans, Peter; Mercer, Deana; McKee, Desirae M.; Dučić, Ivica

doi:10.1097/sap.0000000000002767

Cited by 21 publications

(22 citation statements)

References 216 publications

(470 reference statements)

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“…The timing of surgery is considered an important factor for optimal return of sensation [29]. A recent publication suggested that acute repair should be performed within 14 days of injury [30]. In our study 124 patients (12%) waited over 7 days for nerve repair and 50 patients (5%) waited more than 14 days.…”

Section: Plos Onementioning

confidence: 64%

Incidence, demographics and rehabilitation after digital nerve injury: A population-based study of 1004 adult patients in Sweden

et al. 2023

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Objective The main objective of this study was to describe the epidemiology of surgically repaired digital nerve injuries in a Swedish population. Secondary objectives were to describe the demographics of the patient population, injury characteristics, post-operative care and rehabilitation. Methods From 2012 to 2018, 1004 patients with a surgically repaired digital nerve injury resident in the Stockholm region were identified in the Swedish national quality registry for hand surgery and all medical records were thoroughly reviewed. Results The incidence rate was 8.3 per 100.000 person-years and these injuries were more common in men than women. The median age at the time of injury was 37 years and a sharp cut was the most common mechanism of injury. Injuries were equally distributed over weekdays and the year, but surgery was most often performed on Mondays. There were no differences in treatment and rehabilitation regimens between sexes, except women were more likely than men to be operated within three days from injury. Timing and content of rehabilitation varied largely between individuals. One third of patients did not receive any sensory relearning and sensory assessment was performed in only 7%. Conclusion The epidemiology shows no major changes over the last decade. However, we found a large individual variation in follow up visits, rehabilitation content and assessments indicating large differences in consumption of health care resources. Our findings expose the need to further improve and evaluate rehabilitation regimens after digital nerve injury.

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Section: Plos Onementioning

confidence: 64%

Incidence, demographics and rehabilitation after digital nerve injury: A population-based study of 1004 adult patients in Sweden

et al. 2023

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“…109,[116][117][118] A recent review by MacKay et al recommended that after blunt trauma or GSW, if the zone of injury is clearly established, immediate exploration and peripheral nerve repair may be warranted as to avoid long-term nervous insufficiency. 119 The advantages of early exploration include improved outcomes and shorter graft length requirements, which may be attributable to avoiding dense scar tissue formation and intraneural edema. Ultimately, the decision is subject to clinical judgment and individual patient/injury characteristics.…”

Section: Treatment Of Concomitant Injuriesmentioning

confidence: 99%

“…However, when the zone of injury is unclear, a wait time of 2 to 3 weeks is advised. 119 Penetrating injuries that result in vascular injury above the knee and fracture to the proximal tibia are at high risk of causing compartment syndrome. 120…”

Section: Treatment Of Concomitant Injuriesmentioning

confidence: 99%

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Baum¹,

Baum²,

Hayward³

2022

ORR

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As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.

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“…Although the window for repair and functional recovery is generally accepted as within 12 to 15 months, it is ideal for motor nerve regeneration and target reinnervation to actively occur within 3 to 4 months. Some evidence suggests this is a critical time point, after which regeneration outcomes start to become poor [4] . Of note, timing is different with sensory nerves.…”

Section: Overview Of Nerve Injuries and Repairmentioning

confidence: 99%

Distal median and radial nerve branch transfer techniques for upper extremity reanimation

Bryan¹,

Nichols²,

Polansky³

et al. 2022

Plast Aesthet Res

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Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades. While techniques for ulnar nerve repair have been well-documented, more recent techniques for median and radial nerve branch reinnervation are still being explored. This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.

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Evidence-Based Approach to Timing of Nerve Surgery

Cited by 21 publications

References 216 publications

Incidence, demographics and rehabilitation after digital nerve injury: A population-based study of 1004 adult patients in Sweden

Incidence, demographics and rehabilitation after digital nerve injury: A population-based study of 1004 adult patients in Sweden

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Distal median and radial nerve branch transfer techniques for upper extremity reanimation

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