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Gunshot injuries to the brachial plexus during wartime
Mohammad Samadian1, Omidvar Rezaee, Karim Haddadian
1Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. swt_f@yahoo.com
British Journal of Neurosurgery
|March 24, 2009
Summary
Surgical reconstruction for gunshot injuries to the brachial plexus (BP) yielded good outcomes, particularly with neurolysis for lateral cord lesions. Early surgical intervention is recommended for nerve deficits.
Area of Science:
- Neurosurgery
- Peripheral Nerve Surgery
- Trauma Surgery
Background:
- Gunshot injuries to the brachial plexus (BP) present significant challenges in peripheral nerve lesion management.
- Surgical reconstruction outcomes are influenced by various factors, necessitating detailed analysis.
Purpose of the Study:
- To evaluate the results of surgical management for brachial plexus gunshot injuries sustained during the Iran-Iraq war.
- To identify factors influencing recovery and optimal surgical strategies.
Main Methods:
- Retrospective analysis of 20 patients with 55 injured BP elements treated between 1982-1992.
- Surgical procedures included neurolysis, nerve grafting, or a combination, chosen based on intraoperative findings.
- Outcomes assessed at least 3 years post-surgery based on motor and sensory recovery.
Main Results:
- Acceptable recovery rates were high: 94% for neurolysis, 89% for nerve grafting, and 87.5% for combined procedures.
- Good recovery was most frequent with neurolysis (77.5%), especially for lateral cord to musculocutaneous nerve lesions (100% good recovery).
- Lesions of the posterior cord, lower trunk, or C8-T1 did not achieve good recovery.
Conclusions:
- Neurolysis for brachial plexus gunshot injuries, particularly in the lateral cord to musculocutaneous nerve region, yields the most favorable outcomes.
- Prompt surgical intervention is crucial for nerve deficits lacking spontaneous improvement, guided by injury type and location.
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