Nerve injuries sustained during warfare: Part II: Outcomes
2012
The outcomes of 261 nerve injuries in 100 patients
were graded good in 173 cases (66%), fair in 70 (26.8%) and poor in
18 (6.9%) at the final review (median 28.4 months (1.3 to 64.2)).
The initial grades for the 42 sutures and graft were 11 good, 14
fair and 17 poor. After subsequent revision repairs in seven, neurolyses
in 11 and free vascularised fasciocutaneous flaps in 11, the final
grades were 15 good, 18 fair and nine poor. Pain was relieved in
30 of 36 patients by nerve repair, revision of repair or neurolysis,
and flaps when indicated. The difference in outcome between penetrating
missile wounds and those caused by explosions was not statistically
significant; in the latter group the onset of recovery from focal
conduction block was delayed (mean 4.7 months (2.5 to 10.2) vs 3.8
months (0.6 to 6); p = 0.0001). A total of 42 patients (47 lower
limbs) presented with an insensate foot. By final review (mean 27.4 months
(20 to 36)) plantar sensation was good in 26 limbs (55%), fair in
16 (34%) and poor in five (11%). Nine patients returned to full
military duties, 18 to restricted duties, 30 to sedentary work,
and 43 were discharged from military service. Effective rehabilitation
must be early, integrated and vigorous. The responsible surgeons
must be firmly embedded in the process, at times exerting leadership.
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