Microsurgical management of penetrating peripheral nerve injuries: pre, intra- and postoperative analysis and results.
METHODS
Clinical and electrophysiological motor function data were compared before and after microsurgical repair of penetrating peripheral nerve injuries. Sixty-four patients totaling 74 injured nerves (25 gunshot wounds, 49 stab wounds) were treated with external and interfascicular neurolysis and/or interfascicular nerve grafts. Microsurgery was performed 2-12 months after the injury (Group 1, 33 patients,) and 12 months-60 years after the injury (Group 2, 31 patients). The postoperative clinical and electrophysiological follow-up period ranged between 1 and 5 years.


RESULTS
A statistically significant improvement in muscle strength occurred after the microsurgery, compared to before repair, gunshot wounds (p < 0.001), stab wounds (p < 0.001). Intraoperative and postoperative electrophysiological analysis showed statistically significant improvement. TIMING OF SURGERY: No statistically significant difference in muscle strength occurred between the 2 groups after the surgery, each showing statistically significant improvement, Group 1 (p < 0.001), Group 2 (p < 0.001). Patients above and below age of 40 showed an improvement in muscle strength after microsurgery, (p < 0.001) and (p < 0.001), respectively.


CONCLUSIONS
Microsurgery can progressively improve nerve function in penetrating peripheral nerve injuries and lead to significant functional improvement, even when it is delayed for more than one year after the injury.
Rochkind
S
S
Division of Peripheral Nerve Reconstruction, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. rochkind@zahav.net.il
Filmar
G
G
Kluger
Y
Y
Alon
M
M
D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008866:Microsurgery; D008875:Middle Aged; D009046:Motor Neurons; D018482:Muscle, Skeletal / Q000503:physiopathology; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D011999:Recruitment, Neurophysiological; D013997:Time Factors; D014948:Wounds, Gunshot / Q000503:physiopathology / Q000601:surgery*; D014951:Wounds, Stab / Q000503:physiopathology / Q000601:surgery*