THE ROLE OF INTERFASCICULAR NERVE GRAFTING AFTER GUNSHOT WOUNDS - A REPORT OF 44 CASES

In this study the authors present the results of 44 patients with 49 i nterfascicular nerve grafting procedures necessitated by gunshot wound s. The aim was to establish the effectiveness of microsurgical interfa scicular nerve grafting for war injuries. The 49 interfascicular nerve grafting procedures were performed between July 1991 and January 1993 . All but one were performed within 6 months of injury. Nerve recovery was assessed independently by a neurologist. The M/S scale was used f or median, ulnar and redial nerves, and the grading scale recommended by MIllesi was used for the sciatic, tibial and peroneal nerves. Follo w-up was for between 2.5 and 3.5 years. Patients scoring at least M3/S 3+, or Grade 2 on the Millesi, scale, were considered to have useful f unctional recovery which occurred in high median (0 out of 1), low med ian (4 out of 9), high ulnar (0 out of 2), low ulnar (5 out of 11), hi gh radial (4 out of 6), low radial (2 out of 2), sciatic (5 out of 9), peroneal (4 out of 7), and tibial (2 out of 2). The extent of recover y correlated inversely with the patient's age and the length of the gr aft, but was independent of the time between injury and surgery and of presumed projectile energy. Our results suggest that microsurgical in terfascicular nerve grafting is of value in the management of wartime nerve injuries.