Approach to neurosurgical care for combat-related injuries to the peripheral nervous system

Abstract

Gunshot and landmine wounds to the upper and lower extremities are the most common injuries in modern armed conflict. In previous armed conflicts, reconstructive surgery of peripheral nerves was not performed until 3-6 months after injury because dysfunction was often associated with a contusion mechanism of injury and recovery of nerve function may occur without surgical treatment. A new approach to care for patients with peripheral nerve injuries was developed and implemented by the authors. In recent years, the Military Medical Academy has widely used neuroimaging diagnostic techniques, such as magnetic resonance neurography and ultrasound examination of peripheral nerves. They can confirm or rule out a complete anatomical rupture of the nerve trunk. In the presence of characteristic pathomorphologic changes, peripheral nerve reconstructive surgery is performed as early as possible after injury (1.0–1.5 months). The earlier the nerve is reconstructed, the faster and more complete the functional recovery. Care of patients with peripheral nerve injury requires a comprehensive approach and close collaboration between neurosurgeons and related specialists. Such an approach allows identifying peripheral nervous system injuries in incoming surgical patients. This approach has proven effective in the treatment of neuropathic pain in this population. Early reconstructive intervention increases the effectiveness and decreases the time to regain lost limb function, thus shortening the rehabilitation period and improving quality of life.

Keywords

peripheral nervous system injury / combat injury / reconstructive treatment / neurosurgical care / anatomical rupture / surgery on nerve trunks / care

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