TREATMENT OF UPPER-LIMB NERVE WAR INJURIES ASSOCIATED WITH VASCULAR TRAUMA

During a 4-year period, in the Departments of Plastic Surgery and Vasc ular Surgery at the Clinical Hospital Centre in Zagreb, 151 upper limb nerve injuries caused by war weapons were treated using microsurgical procedures, and 119 patients have been assessed. Among them, 44 patie nts with 58 nerve injuries had associated arterial injuries. It is of great importance that peripheral nerve as well as vessel injuries shou ld be considered in all extremity war wounds. Every effort should be m ade to perform immediate revascularization of a damaged artery, as thi s is the best guarantee for long-term arterial patency. Reconstruction with autologous vein has been the method of choice for arterial war i njuries. Injured peripheral nerves, at the time of vascular repair, we re marked and left for secondary reconstruction. Primary repair of suc h injuries was contraindicated because it was impossible to determine the exact proximal and distal extent of injury. Functional results wer e obtained in only 44.8 per cent of cases with concomitant nerve and a rterial war injuries, an outcome that could be explained by insufficie nt vascularization at the site of nerve repair (using both mechanisms of graft revascularization), as well as proximal levels of injury and extent of nerve damage, which resulted in long nerve defects. (C) 1997 Elsevier Science Ltd.