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Harrington CJ, Dearden ME, McGlone P, Potter BK, Tintle SM, Souza JM. The Scope and Distribution of Upper Extremity Nerve Injuries Associated With Combat-Related Extremity Limb Salvage. J Hand Surg Am 2024:S0363-5023(23)00500-2. [PMID: 38219089 DOI: 10.1016/j.jhsa.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Chronic pain and functional limitations secondary to nerve injuries are a major barrier to optimal recovery for patients following high-energy extremity trauma. Given the associated skeletal and soft tissue management challenges in the polytraumatized patient, concomitant nerve injuries may be overlooked or managed in delayed fashion. Whereas previous literature has reported rates of peripheral nerve injuries at <10% in the setting of high-energy extremity trauma, in our experience, the incidence of these injuries has been much higher. Thus, we sought to define the incidence, pain sequelae, and functional outcomes following upper extremity peripheral nerve injuries in the combat-related limb salvage population. METHODS We performed a retrospective review of all patients who underwent limb salvage procedures to include flap coverage for combat-related upper extremity trauma at a single institution between January 2011 and January 2020. We collected data on patient demographics; perioperative complications; location of nerve injuries; surgical interventions; chronic pain; and subjective, patient-reported functional limitations. RESULTS A total of 45 patients underwent flap procedures on 49 upper extremities following combat-related trauma. All patients were male with a median age of 27 years, and 96% (n = 47) of injuries were sustained from a blast mechanism. Thirty-three of the 49 extremities (67%) sustained associated nerve injuries. The most commonly injured nerve was the ulnar (51%), followed by median (30%) and radial/posterior interosseous (19%). Of the 33 extremities with nerve injuries, 18 (55%) underwent surgical intervention. Nerve repair/reconstruction was the most common procedure (67%), followed by targeted muscle reinnervation (TMR, 17%). Chronic pain and functional limitation were common following nerve injury. CONCLUSIONS Upper extremity peripheral nerve injury is common following high-energy combat-related trauma with high rates of chronic pain and functional limitations. Surgeons performing limb salvage procedures to include flap coverage should anticipate associated peripheral nerve injuries and be prepared to repair or reconstruct the injured nerves, when feasible. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Colin J Harrington
- Division of Orthopaedics, Department of Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD.
| | - Marissa E Dearden
- Division of Orthopaedics, Department of Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD
| | - Patrick McGlone
- Division of Orthopaedics, Department of Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD
| | - Benjamin K Potter
- Division of Orthopaedics, Department of Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott M Tintle
- Division of Orthopaedics, Department of Surgery, Uniformed Services University-Walter Reed National Military Medical Center, Bethesda, MD
| | - Jason M Souza
- Department of Plastic and Reconstructive Surgery & Orthopaedic Surgery, Ohio State University, Columbus, OH
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2
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Bryan AE, Krutko M, Westphal J, Sheth M, Esfandiari L, Harris GM. Ultrasound-Activated Piezoelectric Polyvinylidene Fluoride-Trifluoroethylene Scaffolds for Tissue Engineering Applications. Mil Med 2023; 188:61-66. [PMID: 37948229 DOI: 10.1093/milmed/usad018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 11/12/2023] Open
Abstract
Severe peripheral nervous system (PNS) injuries have limited options for therapeutic solutions to regain functional recovery. This can be attributed in part to the lack of regeneration pathways promoted by recapitulating chemical, physical, and electrical cues to direct nerve guidance. To address this, we examined ultrasonic stimulation of a piezoelectric polyvinylidene fluoride-triflouroethylene (PVDF-TrFE) scaffold as a potentially clinically relevant therapy for PNS regeneration. Owing to the piezoelectric modality of PVDF-TrFE, we hypothesize that ultrasound stimulation will activate the scaffold to electrically stimulate cells in response to the mechanical deformation mediated by sound waves. Biocompatible PVDF-TrFE scaffolds were fabricated to be used as an ultrasound-activated, piezoelectric biomaterial to enhance cellular activity for PNS applications. NIH-3T3 fibroblasts were cultured on PVDF-TrFE nanofibers and stimulated with low-, medium-, or high-powered ultrasound. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assays were performed on fibroblasts to measure the metabolic activity of the cells following stimulation. MTT assays showed that ultrasound-stimulated fibroblasts on PVDF-TrFE scaffolds had increased metabolic activity as power was increased, whereas on plain polystyrene, an opposite trend was observed where cells had a decreased metabolic activity with ascending levels of ultrasound power. Ultrasound-stimulated PVDF-TrFE nanofibers hold exciting potential as a therapy for PNS injuries by promoting increased metabolic activity and proliferation. The ability to noninvasively stimulate implantable piezoelectric nanofibers to promote mechanical and electrical stimulation for nerve repair offers a promising benefit to severe trauma patients.
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Affiliation(s)
- Andrew E Bryan
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Maksym Krutko
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Jennifer Westphal
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Maulee Sheth
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Leyla Esfandiari
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
- Department of Electrical Engineering and Computer Science, University of Cincinnati, Cincinnati, OH 45221, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Greg M Harris
- Department of Chemical and Environmental Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA
- Neuroscience Graduate Program, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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3
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Tarkunde YR, Clohisy CJ, Calfee RP, Halverson SJ, Wall LB. Firearm Injuries to the Wrist and Hand in Children and Adults: An Epidemiologic Study. Hand (N Y) 2023; 18:575-581. [PMID: 34872366 PMCID: PMC10233640 DOI: 10.1177/15589447211058815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gunshot wounds (GSWs) to the wrist and hand are a major health and economic burden in the United States. There are few studies examining the circumstances and epidemiological factors surrounding these injuries. This study assesses the epidemiological factors, as well as the shooting circumstances, injury details, and surgical management of wrist and hand GSWs in children and adults. METHODS Medical records and radiographs were reviewed for all patients with ballistic injury to the wrist or hand treated at an urban academic level 1 trauma center from 2016 to 2019. Fisher exact and Pearson χ2 tests were used to assess differences between groups. RESULTS Two hundred forty-nine victims (29 children, 220 adults) with complete documentation were identified. Among 180 victims with known shooting circumstances, 132 (70%) were shot by another person and 110 (65%) were injured by intentional gunfire. Eighty-seven victims (35%) suffered a concurrent GSW to another body region. Metacarpal fracture was the most commonly diagnosed bony injury (37%), followed by proximal phalanx fracture (25%). One hundred twenty-nine victims (52%) underwent surgery following their injuries. Nerve discontinuity was diagnosed in 27 victims (11%), while 20 victims (8%) had vascular disruption. There was no significant difference between children and adult victims' type of fracture, concurrent injuries, rates of surgery, or in the most common fracture fixation method. CONCLUSIONS Most wrist and hand GSW victims were injured due to intentional, non-self-inflicted gunfire. Most patients present with hand fractures, and fortunately, nerve and vascular disruptions are uncommon.
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Affiliation(s)
- Yash R Tarkunde
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Clayton J Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Schuyler J Halverson
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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4
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Sharifi M, Farahani MK, Salehi M, Atashi A, Alizadeh M, Kheradmandi R, Molzemi S. Exploring the Physicochemical, Electroactive, and Biodelivery Properties of Metal Nanoparticles on Peripheral Nerve Regeneration. ACS Biomater Sci Eng 2023; 9:106-138. [PMID: 36545927 DOI: 10.1021/acsbiomaterials.2c01216] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite the advances in the regeneration/rehabilitation field of damaged tissues, the functional recovery of peripheral nerves (PNs), especially in a long gap injury, is considered a great medical challenge. Recent progress in nanomedicine has provided great hope for PN regeneration through the strategy of controlling cell behavior by metal nanoparticles individually or loaded on scaffolds/conduits. Despite the confirmed toxicity of metal nanoparticles due to long-term accumulation in nontarget tissues, they play a role in the damaged PN regeneration based on the topography modification of scaffolds/conduits, enhancing neurotrophic factor secretion, the ion flow improvement, and the regulation of electrical signals. Determining the fate of neural progenitor cells would be a major achievement in PN regeneration, which seems to be achievable by metal nanoparticles through altering cell vital approaches and controlling their functions. Therefore, in this literature, an attempt was made to provide an overview of the effective activities of metal nanoparticles on the PN regeneration, until the vital clues of the PN regeneration and how they are changed by metal nanoparticles are revealed to the researcher.
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Affiliation(s)
- Majid Sharifi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Mohammad Kamalabadi Farahani
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran.,Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Amir Atashi
- Stem Cell and Tissue Engineering Research Center, Faculty of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Morteza Alizadeh
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Rasoul Kheradmandi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
| | - Sahar Molzemi
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran.,Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, 3614773955, Iran
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5
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Patzkowski JC, Dunn JC. Editorial Comment: Selected Proceedings From the Society of Military Orthopaedic Surgeons 2021 Annual Meeting. Clin Orthop Relat Res 2022; 480:2108-2110. [PMID: 36173767 PMCID: PMC9555938 DOI: 10.1097/corr.0000000000002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jeanne C. Patzkowski
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
| | - John C. Dunn
- Assistant Professor of Surgery, Texas Tech University, El Paso, TX, USA
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Peruri A, Morgan A, D’Souza A, Mellon B, Hung CW, Kayal G, Shin H, Nguyen K, Zahed M, Yount M, Ellis R, Wynne T, Fritz V, Simmons Z, Roballo KCS. Pineal Gland from the Cell Culture to Animal Models: A Review. Life (Basel) 2022; 12:1057. [PMID: 35888145 PMCID: PMC9317964 DOI: 10.3390/life12071057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 12/11/2022] Open
Abstract
This review demonstrates current literature on pineal gland physiology, pathology, and animal model experiments to concisely explore future needs in research development with respect to pineal gland function and neuro-regenerative properties. The pineal gland plays an integral role in sleep and recovery by promoting physiologic circadian rhythms via production and release of melatonin. Yet, the current literature shows that the pineal gland has neuroprotective effects that modulate both peripheral and central nerve injuries through several direct and indirect mechanisms, such as angiogenesis and induction of growth factors and anti-inflammatory mediators. Animal models have also shown correlations between pineal gland function and metabolic homeostasis. Studies have shown that a functional pineal gland is essential in preventing and slowing the progression of certain diseases such as diabetes, osteoporosis, vertebral osteoarthritis, and neurodegenerative processes. Lastly, the array of cell culturing methods and animal models that can be used to further develop the study of pineal gland function and nervous system injury were reviewed.
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Affiliation(s)
- Alekhya Peruri
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Alexandra Morgan
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Alida D’Souza
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Bridget Mellon
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Carey W. Hung
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Gabriella Kayal
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Haejung Shin
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Kim Nguyen
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Malek Zahed
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Mason Yount
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Reilly Ellis
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Taylor Wynne
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Virginia Fritz
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Zachary Simmons
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
| | - Kelly C. S. Roballo
- Biomedical Affairs and Research, Edward Via College of Osteopathic Medicine, 2265 Kraft Drive, Blacksburg, VA 24060, USA; (A.P.); (A.M.); (A.D.); (B.M.); (C.W.H.); (G.K.); (H.S.); (K.N.); (M.Z.); (M.Y.); (R.E.); (T.W.); (V.F.); (Z.S.)
- Department of Biomedical Sciences and Pathobiology, Virginia Maryland College of Veterinary Medicine, Virginia Tech, 1410 Prices Fork, Blacksburg, VA 24060, USA
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Brown KV, Roberts DC, Wordsworth M, Duraku LS, Jose RM, Power DM, Stapley SA. Management of conflict injuries to the upper limb. Part 1: assessment and early surgical care. J Hand Surg Eur Vol 2022; 47:687-697. [PMID: 35579217 DOI: 10.1177/17531934221098916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Upper limb injuries are common in conflict zones. The functions of the upper limb are impossible to replicate with prosthetic replacement and wherever possible attempts should be made to preserve the limb with further secondary reconstruction aimed at restoration of function. Casualty assessment, haemorrhage control and resuscitation are simultaneously undertaken at the receiving medical facility. Primary surgical management involves decontamination and debridement, skeletal stabilization, restoration of vascularity, compartment fasciotomy where indicated and wound temporization with dressings. Operative findings and interventions should be documented and if evacuation of the casualty is possible, copies should be provided in the medical records to facilitate communication in the chain of care. Secondary procedures are required for further assessment and debridement prior to planning reconstruction and definitive fracture stabilization, nerve repair, wound cover or closure.
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Affiliation(s)
- Kate V Brown
- The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Pulvertaft Hand Unit, Derby Royal Hospital, Derby, UK
| | - Darren C Roberts
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Matthew Wordsworth
- The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands.,The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rajive M Jose
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic M Power
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah A Stapley
- The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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8
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Lower Extremity Combat Sustained Peripheral Nerve Injury in US Military Personnel. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3447. [PMID: 33747687 PMCID: PMC7963502 DOI: 10.1097/gox.0000000000003447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Background: Since the civil war, combat sustained peripheral nerve injuries (CSPNI) have been documented during wartime. Warfare has evolved and current combat involves a greater severity of blast injuries secondary to increased use of improvised explosive devices. The purpose of this study was to describe CSPNI and report outcomes after evaluation and treatment. We hypothesize that a shorter time to evaluation will improve outcomes. Methods: A database including all active duty service members who sustained a CSPNI and were treated by the PNC between 2004 and 2009 was used. Service member demographic information, injury mechanism, CSPNI description, and Medical Research Council (MRC) final motor and sensory outcomes were queried from this database. Results: One hundred and four military service members sustained 144 PNIs. The average age was 26.7 years, and nearly all were men (98.1%). There was no correlation between Sunderland classification and age, specific PNI, injury type, or time to evaluation. Higher Sunderland classifications were found to be correlated with worse final motor (r = 0.51, P < 0.001) and final sensory (r = 0.41, P < 0.001) scores. Final motor and sensory scores were not associated with specific nerve injury, mechanism of injury, initial EMG, or surgical procedure. Shorter time to initial assessment was associated with improved final motor and sensory scores, but was not found to be statistically significant. Conclusions: As the complexity of CSPNIs progress as combat weaponry evolves, a firm understanding of treatment factors is important. Our study demonstrates in recent conflict that military service members’ initial injury severity is a key factor in expected outcome.
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