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Optimal timing for repair of peripheral nerve injuries

Wang, Eugene MD; Inaba, Kenji MD; Byerly, Saskya MD; Escamilla, Diandra; Cho, Jayun MD; Carey, Joseph MD; Stevanovic, Milan MD; Ghiassi, Alidad MD; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 875–881
doi: 10.1097/TA.0000000000001570
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BACKGROUND Data regarding outcomes after peripheral nerve injuries is limited, and the optimal management strategy for an acute injury is unclear. The aim of this study was to examine timing of repair and specific factors that impact motor-sensory outcomes after peripheral nerve injury.

METHODS This was a single-center, retrospective study. Patients with traumatic peripheral nerve injury from January 2010 to June 2015 were included. Patients who died, required amputation, suffered brachial plexus injury, or had missing motor-sensory examinations were excluded. Motor-sensory examinations were graded 0 to 5 by the Modified British Medical Research Council system. Operative repair of peripheral nerves was analyzed for patient characteristics, anatomic nerve injured, level of injury, associated injuries, days until repair, and repair method.

RESULTS Three hundred eleven patients met inclusion criteria. Two hundred fifty-eight (83%) patients underwent operative management, and 53 (17%) underwent nonoperative management. Those who required operative intervention had significantly more penetrating injuries 85.7% versus 64.2% (p < 0.001), worse initial motor scores 1.19 versus 2.23 (p = 0.004), and worse initial sensory examination scores 1.75 versus 2.28 (p = 0.029). Predictors of improved operative motor outcomes on univariate analysis were Injury Severity Score less than 15 (p = 0.013) and male sex (p = 0.006). Upper arm level of injury was a predictor of poor outcome (p = 0.041). Multivariate analysis confirmed male sex as a predictor of good motor outcome (p = 0.014; Adjusted Odds Ratio, 3.88 [1.28–11.80]). Univariate analysis identified distal forearm level of injury (p = 0.026) and autograft repair (p = 0.048) as predictors of poor sensory outcome. Damage control surgery for unstable patients undergoing laparotomy (p = 0.257) and days to nerve repair (p = 0.834) did not influence motor-sensory outcome. Outcomes did not differ significantly in patients who underwent repair 24 hours or longer versus those who were repaired later.

CONCLUSION Outcomes were primarily influenced by patient characteristics and injury level rather than operative characteristics. Peripheral nerve injuries can be repaired after damage control surgery without detriment to outcomes.

LEVEL OF EVIDENCE Prognostic study, level III.

Supplemental digital content is available in the text.

From the Division of Trauma and Critical Care, LAC+USC Medical Center (E.W., K.I., S.B., D.E., J.C., J.C., M.S., A.G.).

Submitted: October 2, 2016, Revised: April 14, 2017, Accepted: April 23, 2017, Published online: June 5, 2017.

This study was presented at the 75th annual meeting of The American Association for the Surgery of Trauma, September 14–17, 2016, in Waikoloa, Hawaii.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Eugene Wang, MD, LA County + USC Medical Center 2051 Marengo Street, Inpatient Tower, C5L100 Los Angeles, CA 90033; email: ewangwhc@gmail.com.

© 2017 Lippincott Williams & Wilkins, Inc.