Microsurgical Management of 140 Gunshot and Stab Peripheral Nerve Injuries: Clinical and Electrophysiological Analysis and Results

A prospective study was conducted of patients suffering from gunshot and stab peripheral nerve injuries in order to show that functional improvement was possible after interfascicular neurolysis or interfascicular nerve grafts, even more than 1 year after injury.

Clinical and electrophysiological data on 140 patients were compared before and after interfascicular neurolysis or nerve grafts. Microsurgery was performed during the first year or 1 to 5 years after injury. Follow-up after the operation was from 1 to 5 years. A statistical clinical and electrophysiological analysis was done in order to compare motor functional activity using MRC grade scale prior to and after surgery; to compare amplitude and latency changes of compound muscle action potentials (CMAP) and recruitment (voluntary muscle activity) prior to and after the surgery.

Statistically significant improvement in muscle strength occurred after microsurgery, compared to before repair—gunshot wounds (p < 0.001) and stab wounds (p < 0.001). Postoperative electrophysiological analysis showed statistically significant improvement in amplitude of CMAP (p < 0.001) and recruitment (p = 0.002), compared to before surgery.

Although the optimal period for microsurgery of penetrating peripheral nerve injuries is between 3–6 months, in cases where microsurgery was delayed, it also could progressively improve nerve function.