Peripheral Neurovascular Injuries

Abstract

SUMMARY:

This prospective 5-year research study describes 46 male patients with peripheral neurovascular injuries and is the largest reported series from this region at the present time. High-powered rifle injuries accounted for 91 % ofthe lesions. Clavio-axillary region sustained 76% of the injuries. 3 patients presented directly with primary neurovascular injuries whilst the remainder (93%) presented at an average delay of 19 weeks when the neurological deficit was deteriorating (84.7 %) or had failed to improve (15.3 %) spontaneously.In our series the early results were good, for both the vascular as well as neurological lesions but poor re-attendance on subsequent follow-ups has seriously affected the interpretation of the final outcome on a long term basis. It is hoped that this can be rectified through patient-education and better colleague co-operation in the future.

Discussion:

Bullet wounds cause primary track formation which results in disintegration of soft tissue in the tunnel of the track. This is also associated with considerable regional disruption of the neurovascular structures caused by the secondary shock wave effect. The development of an aneurysm is a slow process caused by leakage of blood in the form of a haematoma after the arterial wall has ruptured from penetration or from the remote shock wave effect.When the nerve injury is clean and almost surgica1 primary repair by neurorrhaphy gives the best results provided the anastomosis is tension4ree and the nerve orientation is anatomically correct.