Peripheral Nerve Injuries: An International Survey of Current Treatments and Future Perspectives

ABSTRACT

Peripheral nerve injuries are a serious health concern and leave many patients with lifelong disabilities. There is little information about incidences, current practice, outcomes, and type of research that may help delineate new strategies. A questionnaire was designed to determine characteristics of peripheral nerve injuries and the need for alternative strategies and sent to 889 plastic, hand, trauma, and orthopedic surgeons in 49 countries; 324 completed surveys were collected and analyzed (total response rate of 36.45%). The majority of institutions treat more than 3000 patients annually. Trauma was the leading cause of injury with the majority located on the upper extremity. In most cases, a primary repair was achieved, but 2.52% were unrepairable. The overall outcome was linked to their Sunderland classification (SCL). A grade 1 nerve injury (SCL-1) reached a maximum outcome after 7.15 months. SCL-2, -3, -4, and -5 needed 10.69, 14.08, 17.66, and 19.03 months, respectively. Tissue engineering was considered the most important research field, resulting in a visual analogue scale of 8.6. Despite marked advances in the treatment of peripheral nerve injuries, clinical outcomes still appear unsatisfactory. The importance of research in the field of tissue engineering should be emphasized as a pathway toward improving these outcomes.

KEYWORDS

Peripheral nerve injury - clinical outcomes - international survey

REFERENCES

• 1 Selecki B R, Ring I T, Simpson D A et al.. Trauma to the central and peripheral nervous systems: Part I: An overview of mortality, morbidity and costs; N.S.W. 1977.  Aust N Z J Surg. 1982;  52 93-102
• 2 Kouyoumdjian J A. Peripheral nerve injuries: a retrospective survey of 456 cases.  Muscle Nerve. 2006;  34 785-788
• 3 Sunderland S. A classification of peripheral nerve injuries producing loss of function.  Brain. 1951;  74 491-516
• 4 Selecki B R, Ring I T, Simpson D A et al.. Trauma to the central and peripheral nervous systems. Part II: A statistical profile of surgical treatment New South Wales 1977.  Aust N Z J Surg. 1982;  52 111-116
• 5 Taylor C A, Braza D, Rice J B et al.. The incidence of peripheral nerve injury in extremity trauma.  Am J Phys Med Rehabil. 2008;  87 381-385
• 6 Noble J, Munro C A, Prasad V S et al.. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries.  J Trauma. 1998;  45 116-122
• 7 Jaquet J B, Luijsterburg A J, Kalmijn S et al.. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity.  J Trauma. 2001;  51 687-692
• 8 Kim D H, Cho Y J, Tiel R L et al.. Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center.  J Neurosurg. 2003;  98 1005-1016
• 9 Midha R. Nerve transfers for severe brachial plexus injuries: a review.  Neurosurg Focus. 2004;  16 E5
• 10 de Medinaceli L, Prayon M, Merle M. Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation: review of 2,181 nerve lesions.  Microsurgery. 1993;  14 244-246
• 11 Kline D G, Kim D, Midha R et al.. Management and results of sciatic nerve injuries: a 24-year experience.  J Neurosurg. 1998;  89 13-23
• 12 Midha R. Epidemiology of brachial plexus injuries in a multitrauma population.  Neurosurgery. 1997;  40 1182-1188 discussion 1188-1189
• 13 Kim D H, Kline D G. Surgical outcome for intra- and extrapelvic femoral nerve lesions.  J Neurosurg. 1995;  83 783-790
• 14 Wilcke O, Sanker P. Peripheral nerve lesions in multiple injuries.  Neurosurg Rev. 1989;  12(Suppl 1) 55-58
• 15 Portincasa A, Gozzo G, Parisi D et al.. Microsurgical treatment of injury to peripheral nerves in upper and lower limbs: a critical review of the last 8 years.  Microsurgery. 2007;  27 455-462
• 16 Matejcik V. Peripheral nerve reconstruction by autograft.  Injury. 2002;  33 627-631
• 17 Babar S M. Peripheral nerve injuries in a third world country.  Cent Afr J Med. 1993;  39 120-125
• 18 Beazley W C, Milek M A, Reiss B H. Results of nerve grafting in severe soft tissue injuries.  Clin Orthop Relat Res. 1984;  208-212
• 19 Millesi H. Reappraisal of nerve repair.  Surg Clin North Am. 1981;  61 321-340
• 20 Dellon A L, Mackinnon S E. An alternative to the classical nerve graft for the management of the short nerve gap.  Plast Reconstr Surg. 1988;  82 849-856
• 21 Schwartz S. Principles of Surgery. New York; McGraw-Hill 1999