The outcomes of late term surgical treatment of penetrating peripheral nerve injuries

Abstract

In previous studies, the incidence of PNI has been reported to be 13 to 23 per 100 000 individuals per year. PNIs have been estimated to affect between 1.64% and 2.8% of all trauma patients (24,31). PNI is a common problem, especially in young adult men, and may cause serious disability in this productive age group unless the injured nerve is repaired (1, 22, 24). █ INTRODUCTIONPeripheral nerve injury (PNI) is still a significant cause of morbidity and disability throughout the world. Physical trauma, including traffic accidents and injuries due to sharp and penetrating objects such as broken glass, gunshots, falls and fractures, is the most common cause of PNI AIm: The aim of this retrospective study was to evaluate the follow-up results of patients who received late-term surgical treatment for peripheral nerve lesions caused by penetrating injuries. mATERIAl and mEThODS:The study included 25 patients who underwent surgery for peripheral nerve injuries in our clinic between 2007 and 2013. The patients were evaluated with respect to age, gender, etiology of the trauma, the affected nerve, clinical examinations, electrophysiological findings, surgical techniques and functional outcomes. RESUlTS:The study included 30 nerves of 25 patients (19 male, 6 female; mean age 30.1 years). The mean time between the initial injury and admission to our clinic was 11.5 months (range, 3 to 30 months). Cuts caused by glass were the most common cause of injury (68.5%). The most commonly injured nerves in our patients were the median nerve (43.4%) and ulnar nerve (26.6%). external neurolysis and decompression were performed in eleven patients, epineurotomy and internal neurolysis were performed in eight patients, epineural repair was performed in fourteen patients, fascicular repair was performed in three patients, and interfascicular anastomosis using sural nerve grafting was performed in five patients. Postoperative motor strength and electrophysiological analyses showed significant improvements. Better outcomes were obtained in cases with median nerve injuries rather than other nerve injuries. Additionally, patients undergoing external neurolysis and decompression exhibited better outcomes than those undergoing other surgical approaches. CONClUSION:Although surgical treatment is recommended as early as possible for peripheral nerve injuries, late-term surgical treatments may provide positive outcomes.

Immediate versus delayed primary repair of the sciatic nerve in a nerve transection model in rats

“…Erakat et al [8] reported that the injury to surgery interval is the most significant prognostic factor in a study evaluating the timing of repair of the lingual nerve injury. Gezercan et al [3] reported in a series consisting of 25 nerve injuries repaired 3-30 months after the injury that only 23.4% of the cases had 4-5/5 motor strength at the end of a 15 month follow-up period. There are some studies reporting better clinical results with early primary repair than delayed repair for upper extremity nerves.…”

“…In this study, we aimed to evaluate the effects of immediate versus subacute, or with the term frequently used in literature, delayed primary (after seven days) repair of peripheral nerve injury [3] on histological results of axon degeneration and weights of end-organ muscles in a transaction type sciatic nerve injury model in rats.…”

Biomaterial-based regenerative therapeutic strategies for spinal cord injury

“…The most common approach to repair peripheral nerve injuries is surgical direct repair/direct coaptation 11 . When the gap in a peripheral injury exceeds 5 mm, autograft reconstruction is often used as the "gold standard" treatment 12,13 .…”