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Updated: Sep 16, 2025
Author Spotlight: Regenerative Peripheral Nerve Interface (RPNI) Surgery in Postamputation Pain Management
Published on: March 15, 2024
Early surgical intervention in combat-related peripheral nerve injuries: Lessons from a consecutive cohort from the
Jordan Lachnish1, Anna Seltser2, Zvi Steinberger1
1Department of Hand Surgery and Limb Salvage Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan, 5265601, Israel.
Purpose:
Combat-related peripheral nerve injuries (CRPNIs) are frequently associated with significant long-term disability. While conventional practice often favors delayed exploration to avoid unnecessary interventions, emerging evidence supports early intervention.
Methods:
We retrospectively reviewed 184 patients (265 CRPNIs) treated during the first ten months of the 2023-2024 Israel-Hamas war. Collected data included demographics, injury details, surgical timing, intraoperative findings, procedures performed, and postoperative complications. Surgical Explorations were considered positive if partial/complete nerve transection or nerve compression (e.g., by shrapnel or bone fragment) were found.
Results:
Of 184 patients, 136 (74%) underwent nerve exploration at a median of 8 days post-injury, with positive findings in 72% of these cases. Definitive nerve procedures (DNP), such as direct repair or graft reconstruction, were performed in 48% of explored cases, yielding a 5% perioperative complication rate. Early DNP recipients had significantly fewer secondary nerve procedures than those managed nonoperatively (19% vs. 38%, p=0.01).
Conclusions:
Early surgical exploration in CRPNIs demonstrated a high rate of actionable findings and reduced the subsequent need for surgical interventions, supporting a more aggressive initial approach. Further studies are warranted to determine long-term functional outcomes.
