Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma

Object. The purpose of this study was to discover the number and types of i atrogenic nerve injuries that were surgically treated during a 9-year perio d at a relatively busy nerve center. The specific nerves involved, their si tes of injury, and the mechanisms of injury were also documented. Methods. The authors retrospectively evaluated the surgically treated iatro genic lesions by reviewing case histories, operative reports, and follow-up notes in 722 cases of trauma. These cases were treated between January 199 0 and December 1998 because of pain, dysesthesias, and sensory and/or motor deficits. Iatrogenic injury was a much larger category of trauma than predicted. One hundred twenty-six (17.4%) of the 722 surgically treated cases were iatroge nic in origin. Most of these injuries occurred during a previous operation. To a major extent, nerves of the extremities were affected, and a relative ly large number of injuries occurred in the neck and groin. Incidence was h ighest in the spinal accessory nerve (14 cases), the common peroneal nerve (11 cases), the superficial radial nerve (10 cases), the genitofemoral nerv e branches (10 cases), and the median nerve (nine cases). At least two thir ds of the patients did not undergo surgery for the iatrogenic injury within an optimal time interval due to delayed referral. Follow-up data were avai lable in 97 of the 126 patients. Surgical outcomes demonstrated improvement in 70% of patients. Operative results were especially favorable in patient s suffering from iatrogenic injuries to the accessory and superficial senso ry radial nerves. Conclusions. Iatrogenic injuries should be corrected in a timely fashion ju st like any other traumatic injury to nerve.