Current approaches to diagnosis and treatment of gunshot wounds of extremity nerve trunks

The Neurosurgery Clinic of the S. M. Kirov Military Medical Academy has developed and implemented a novel concept for providing care to the wounded with peripheral nerve injuries. Until recently, surgical injuries to the peripheral nervous system were treated with wait-and-see tactics based on the experience of previous military conflicts. Nerve reconstruction interventions were performed no earlier than 3–6 months after the injury. This was explained by the fact that nerve dysfunction after injury was usually associated with a contusion mechanism of damage and restoration of its operability could occur without surgery. In recent years, various neuroimaging diagnostic methods, including ultrasound examination of peripheral nerves and magnetic resonance (MR) neurography, have been actively developed at the S. M. Kirov Military Medical Academy. The earliest possible application of these methods makes it possible to identify and differentiate the nature of nerve damage and the possibility of its further recovery. Ultrasound can be used immediately after surgical wound healing is achieved after initial surgical debridement, and MR-neurography — after removal of metallic foreign bodies. In case of development of pathomorphological changes, it is advisable to carry out reconstructive surgery as early as possible. The use of this approach makes it possible to restore the integrity of the nerve within the first 1–1.5 months after injury, as a result of which the probability of restoring its function increases. The interaction of a neurosurgeon and a neurologist is one of the most important elements of the new concept of providing care to the wounded with peripheral nerve damage. Such joint activities have proven their effectiveness both in the adequate treatment of neuropathic pain in this category of the injured, and in timely rehabilitation treatment under the supervision by a neurologist.