Extremity Peripheral Nerve Injuries: Is There Any Role of Specialized Field Hospital in the Management of Low-Velocity Penetrating Peripheral Nerve Injuries?

Abstract

Background data: Peripheral nerve injuries by either gunshot missiles or shrapnel from barrel bomb explosions are common during war. Purpose: This article aims to analyze the role and ef fi cacy of movable fi eld hospitals in managing penetrating peripheral limb injuries within a war zone area. Study design: A retrospective descriptive clinical case study was performed. Patients and methods: The authors studied the effect of penetrating peripheral nerve injuries from barrel bomb ex-plosions on 25 (out of 30) patients of any age operated on during a period of 6 months in the Syrian civil war (between October 2012 and March 2013). Surgeries were done in fi eld hospitals along the Syria e Turkey border, and surgeries ranged from neurolysis, end-to-end fascicular, to graft repair under general or local anesthesia. Result: The mean age of the patients was 26.2 ± 7.4 years, and nearly all cases were males except for only one female. The most commonly affected nerve was the radial nerve (28%), followed by the common peroneal nerve (28%). Findings injuries were frequently found near to elbow or knee joints. Most of the injuries of victims (80%) were immediately repaired, and 20% were repaired weeks later after injury. Most cases had primary surgical repair of the nerve (64%), and two cases (8%) had repairs twice owing to an infected wound and a lacerated nerve. The sural graft was done in 16%. Neuromas were found in 20% of cases. The authors were unable to follow-up with all patients, and many patients were lost to follow-up. The most common complication was infection (12%). Complications were signi fi cantly related to wounds nearby joints ( P ¼ 0.043) and associated bone or tendon injuries ( P ¼ 0.012). Conclusion: According to this study, shrapnel injury can cause serious nerve injuries similar to gunshot wounds. A movable fi eld hospital near to war zone area can provide surgical management opportunities for nerve injuries in less critical patients. The most frequently affected site was near the elbow or knee joints. The effects of metal fragments detected near/or inside the nerve and long-term follow-up are major limitations in this study.