Treatment of Peripheral Nerve Injuries Sustained in War

Sorin Daniel Iordache 1 Albert Gorski 2 Marwa Nahas 3 Nimrod Rahamimov 2
1Hand Surgery Unit, Galilee Medical Center, Israel
2Department of Orthopedic Surgery B, Galilee Medical Center, Israel
3Occupational Therapy, Galilee Medical Center, Israel

Introduction: We wish to report our experience at the Galilee Medical Centre treating Syrian patients with peripheral nerve injuries sustained in war.

Methods: Data was retrospectively obtained from our hospital's electronic medical records. We included all Syrian patients treated for a peripheral nerve injury at the Hand Surgery Unit from December 2014 through July 2016. The demographic parameters and the diagnoses were collected. Both the general trauma treatment and the specific upper limb procedures were reviewed.

Results: Twenty six patients, at an average age of 26±10 years, sustained 33 nerve injuries. Nine patients suffered multiple injuries and 17 had isolated upper limb trauma. The etiology was a gunshot injury in 11 patients and a blast injury in 15. There were 4 brachial plexus injuries, 14 ulnar nerve, 8 median nerve, 5 radial nerve and 2 sciatic nerve injuries. The associated injuries were fracture in 11 patients, soft tissue defects in 6, vascular injury in 5, infection in 3, and a third degree burn in 1 patient.

Nineteen patients with clinically complete palsy in 24 nerves underwent exploration. Five (21%) nerves were in continuity, 3 (12%) had a partial transection and 16 (67%) were completely transected. Surgery was performed at an average 70±83 days from injury. In five patients we proceeded directly with reconstructive procedures. Two patients had a partial palsy and underwent neurolysis. The most commonly performed procedure was nerve coaptation with sural nerve interposition grafting in 13 nerves (39%), followed by tendon transfer in 10 (30%), neurolysis in 7 (21%), direct suture in 2(6%) and neurotization in 2(6%). The in-hospital follow-up was 23±28 days after the procedure.

Conclusions: The majority of the nerve injuries in our series were transections. The numerous associated injuries support a high energy mechanism. A variety of surgical techniques can be used to improve function