Neuroanatomy, Neurapraxia(Archived).

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Abstract

Conflict of interest statement: Disclosure: Grace Marie Nicole Biso declares no relevant financial relationships with ineligible companies. Disclosure: Sunil Munakomi declares no relevant financial relationships with ineligible companies. 4. Eur J Trauma Emerg Surg. 2022 Oct;48(5):3529-3539. doi: 10.1007/s00068-022-01929-8. Epub 2022 Mar 9. Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy. Mathieu L(1)(2)(3), Goncalves M(4)(5), Murison JC(4)(5), Pfister G(4)(5), Oberlin C(6), Belkheyar Z(6). Author information: (1)Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. laurent_tom2@yahoo.fr. (2)French Military Hand Surgery Center, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. laurent_tom2@yahoo.fr. (3)Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France. laurent_tom2@yahoo.fr. (4)Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. (5)French Military Hand Surgery Center, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. (6)Nerve and Brachial Plexus Surgery Unit, Mont-Louis Private Hospital, 8 rue de la Folie-Regnault, 75011, Paris, France. 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. © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. DOI: 10.1007/s00068-022-01929-8