Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy.
Ballistic injuries to peripheral nerves are devastating injuries frequently encountered in modern conflicts and civilian trauma centers. Such injuries often produce lifelong morbidity, mainly in the form of function loss and chronic pain. However, their surgical management still poses significant ch...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 48; no. 5; pp. 3529 - 3540 |
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| Autores principales: | , , , , , |
| Formato: | algorithm diagnostic images pictorial review tables/charts Journal Article |
| Publicado: |
Springer Nature
Oct2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=159499544&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 159499544 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Oct2022 vid: 48 iid: 5 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 159499544 155652281 159499544 159499544 10.1007/s00068-022-01929-8 159499544 ppf: 3529 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy. aug: au: Mathieu, Laurent Goncalves, Melody Murison, James Charles Pfister, Georges Oberlin, Christophe Belkheyar, Zoubir affil: Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France sug: subj: Peripheral Nerves Injuries Wounds, Gunshot Surgery Peripheral Nervous System Diseases Surgery Early Intervention Suture Techniques Sciatic Nerve Injuries Neurosurgery Methods Forensic Ballistics ab: Ballistic injuries to peripheral nerves are devastating injuries frequently encountered in modern conflicts and civilian trauma centers. Such injuries often produce lifelong morbidity, mainly in the form of function loss and chronic pain. However, their surgical management still poses significant challenges concerning indication, timing, and type of repair, particularly when they are part of high-energy multi-tissue injuries. To help trauma surgeons, this article first presents basic ballistic concepts explaining different types of missile nerve lesions, described using the Sunderland classification, as well as their usual associated injuries. Current controversies regarding their surgical management are then described, including nerve exploration timing and neurolysis's relevance as a treatment option. Finally, based on anecdotal evidence and a literature review, a standardized management strategy for ballistic nerve injuries is proposed. This article emphasizes the importance of early nerve exploration and provides a detailed method for making a diagnosis in both acute and sub-acute periods. Direct suturing with joint flexion is strongly recommended for sciatic nerve defects and any nerve defect of limited size. Conversely, large defects require conventional nerve grafting, and proximal injuries may require nerve transfers, especially at the brachial plexus level. Additionally, combined or early secondary tendon transfers are helpful in certain injuries. Finally, ideal timing for nerve repair is proposed, based on the defect length, associated injuries, and risk of infection, which correlate intimately to the projectile velocity. pubtype: Academic Journal doctype: algorithm diagnostic images pictorial review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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