title: Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults.
abstract: BACKGROUND
  The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries.
  
  
  METHODS
  Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions.
  
  
  RESULTS
  The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis.
  
  
  CONCLUSIONS
  Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.
authors.affiliation: Department of Neurosurgery, Gulhane Military Medical Academy, 06018 Etlik-Ankara, Turkey. hisecer@yahoo.com
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Secer
authors.forename: Ilker
authors.initials: I
authors.lastname: Solmaz
authors.forename: Ihsan
authors.initials: I
authors.lastname: Anik
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Izci
authors.forename: Bulent
authors.initials: B
authors.lastname: Duz
authors.forename: Mehmet Kadri
authors.initials: MK
authors.lastname: Daneyemez
authors.forename: Engin
authors.initials: E
authors.lastname: Gonul