According to the materials of the Great Patriotic War in the Department of Medical Medicine, the diagnosis of nerve damage in injuries of the extremities was rarely established.
Injuries of large blood vessels, bones, joints, extensive destruction of soft tissues greatly complicate the detection of nerve damage. Surgical tactics for injuring limbs is aimed at combating bleeding, shock and the prevention of wound infection, the leading role in which, as you know, belongs to the primary surgical treatment of wounds. Excision of non-viable tissues, removal of bone and metal fragments, and carefully performed hemostasis performed during the initial surgical treatment of wounds improve the course of pathological processes in the affected nerve.
During medical sorting of the wounded with injuries of the extremities, special groups of the injured with injuries of the peripheral nerves are not distinguished in the medical and medical department . Medical sorting of the wounded into a limb is carried out according to the rules set out in lesson I of this topic. If it is suspected that the nerve trunk of the limb is suspected, the initial surgical treatment of the wound allows an accurate diagnosis to be made, although the presence of clinical manifestations of nerve damage is not in itself an indication for surgical intervention on the nerve when providing qualified surgical care to the wounded.
In order to clarify the diagnosis, the nerve trunk should not be specifically exposed and searched in the intermuscular spaces if it is not visible during the initial surgical treatment of the wound.
Thus, in case of gunshot wounds of nerves, early operations on them under OMedB (HPLC) conditions are not indicated, except in those rare cases when an anatomical break of the nerve trunk is detected during the operation of the primary surgical treatment of the wound. In such a situation, after thorough surgical treatment of the wound, the primary suture of the nerve can be applied, in all other cases, the usual primary surgical treatment of the wound should be performed and further care should be taken to eliminate, with the help of medical (plaster) tires or plaster bandages, the pathological setting of the limbs caused by damage to another nerve. The following pathological settings of the extremities are usually to be eliminated with giving them a functionally advantageous position: drooping of the hand (falling hand) with paralysis of the radial nerve, drooping of the forearm (lack of active flexion- extensor movements in the elbow joint) with paralysis of the brachial plexus, paralytic drooping foot with paralysis of the sciatic and peroneal nerves, etc.
Giving the limbs a functionally advantageous position can be carried out using ordinary staircases or plaster casts . All nerve trunk damage detected during surgery should be documented in the medical history. This will help to solve medical issues at the stage of specialized treatment of the wounded.
Specialized Medical Assistance
Specialized medical care is provided in the neurosurgical department of the VPTrG GBF. In the neurosurgical department, the nature of nerve damage is specified. They seek to eliminate the infectious process in the wound. After this, the active medical and physiotherapeutic treatment of the wounded begins until the indications for surgery are established. If conservative treatment is not effective, then surgery should be performed no earlier than 8 weeks after wound healing.
Nerve suture is the main surgical technique in reconstructive surgery of peripheral nerves. Types of surgery: 1. Primary suture of the nerve – an intervention on the nerve (suture) is performed simultaneously with the primary surgical treatment of the wound. It is rarely used. 2. Delayed nerve suture: a) early – in the first weeks after damage; b) late – after 3 months from the date of injury. When a nerve is injured, an emergency operation is not required. Immediate surgery is indicated only with compression of the nerve or nerves by the growing hematoma, bone fragments in case of bone fractures, with combined injury to nerves, main arteries or veins of the extremities. The purpose of the operation is to prevent ischemic lesions of the nerve from compression. With combined damage to nerves and bone fractures, osteosynthesis of the damaged bone is primarily performed. Under favorable conditions, the nerve is sutured immediately after osteosynthesis. In complex cases, the transfer of neurography to the second stage leads to adverse consequences. After surgery on the peripheral nerves, medication ( proserin , vitamins) and physiotherapeutic treatment are indicated , including electrical stimulation of the nerve trunk, massage, physiotherapy exercises and other means. Surgical treatment of gunshot injuries of nerves gives quite satisfactory results. The first signs of regeneration after a nerve suture appear after 3-4 months. First, pain and temperature sensitivity are restored, then movements are restored. The restoration of tactile sensitivity occurs after 2-3 years.