Primary Repair of Upper Extremity Peripheral Nerve Injuries: An NSQIP Analysis From 2010 to 2016

Background To identify the rate of 30-day complications after primary repair of upper extremity peripheral nerve injuries, associated diagnoses, and postoperative complication rate. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2010 to 2016. Current Procedural Terminology codes consistent with primary nerve repair of the upper extremity were identified and included in the analysis. Patient demographics, comorbidities, type of procedure (elective/emergent), wound class, operative time, and 30-day complications were recorded. Patients with isolated upper extremity nerve injuries (isolated) were compared with those with peripheral nerve injuries in addition to bone, tendon, or soft tissue injuries (multiple). Results In all, 785 patients were identified as having upper extremity nerve repairs (0.16%). Of them, 64% were men and 36% were women; the average patient age was 40 years. The most common indication for surgery was injury to the digits (54% of cases). Thirty-day adverse events occurred in 3% of all cases. Isolated nerve injury occurred in 43% of patients, whereas 57% had additional injuries. The multiple injury group had a significantly higher complication rate compared with the isolated group (1% vs 4.5%) ( P = .007). Repair of tendon at forearm or wrist was the most common concurrent procedure performed. Conclusions Thirty-day complications among upper extremity peripheral nerve injuries are low, accounting for 3% of cases. Return to the operating room accounted for nearly half of all complications. Patients in the multiple injury group accounted for more than half of these and had a significantly higher complication rate compared with patients with isolated nerve injuries.

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The Epidemiology and Management of Upper Limb Peripheral Nerve Injuries in Modern Practice

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80004-0 ◽

1996 ◽

Vol 21 (1) ◽

pp. 4-13 ◽

Cited By ~ 68

Author(s):

R. M. R. McALLISTER ◽

S. E. A. GILBERT ◽

J. S. CALDER ◽

P. J. SMITH

Keyword(s):

Peripheral Nerve ◽

Nerve Injury ◽

Upper Limb ◽

Primary Repair ◽

Nerve Repair ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Frequency Distributions ◽

South East England ◽

Delayed Referral

This paper reports an epidemiological and clinical study of 813 patients with 1,111 peripheral nerve injuries who were treated for upper limb trauma, which included nerve injury, at two plastic surgery units in south-east England, predominantly between the years 1982 and 1991. The frequency distributions of the levels of nerve injury, and the causes of nerve injury in the sample, are presented, together with the surgical management and timing of nerve repair in these patients. 1,018 clinically suspected nerve injuries in 730 patients (91.6% of nerves, 89.8% of patients) were treated by primary nerve repair, elective delayed nerve repair or primary surgical exploration alone. Divisions of 93 nerves in 83 patients (8.3% of nerves, 10.2% of patients) were treated other than by primary repair or elective delayed repair, due to delayed referral from accident and emergency departments, resulting from missed or uncertain diagnosis at presentation or otherwise unaccounted delay in the initial referral.

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Peripheral Nerve Injuries- An Analysis of 75 Cases

JMS SKIMS ◽

10.33883/jms.v13i1.36 ◽

2010 ◽

Vol 13 (1) ◽

pp. 7-10

Author(s):

Owais Habib ◽

Adil Hafeez ◽

Abdul Rashid Bhat

Keyword(s):

Peripheral Nerve ◽

Peripheral Nerves ◽

Primary Repair ◽

Nerve Repair ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Microsurgical Technique ◽

Injured Nerve ◽

Neural Damage ◽

Civilian Practice

Background: Peripheral neural trauma is a common injury seen both in civilian practice and warfare.Majority of such neural damage is caused by glass cut. The agent causes extnesive damage to te underlying structures from an apparantly looking small incised wound.Material and Method: We explored the wonds of 75 patients under anaesthesia to look for injury to the underlying peripheral nerves. Upon identifying the injured nerve, primary repair using epineural microsurgical technique was carried out using very fine sutures and micro- instruments. The patients were followed sequentailly in the post operative period.Conclusion:When such a protocol was adhered to, the results of nerve repair were excellent in majority of the patients. J Med Sci 2010;13(1):7-10

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Tendon transfers for upper extremity peripheral nerve injuries

Current Orthopaedics ◽

10.1016/0268-0890(91)90048-5 ◽

1991 ◽

Vol 5 (2) ◽

pp. 84-87

Author(s):

M.Mark Hoffer

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Tendon Transfers

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Comparative Strength of Muscles with Similar Function: A Study on Peripheral Nerve Injuries of the Upper Extremity

Physical Therapy ◽

10.1093/ptj/26.2.59 ◽

1946 ◽

Vol 26 (2) ◽

pp. 59-65

Author(s):

Signe Brunnstrom

Keyword(s):

Peripheral Nerve ◽

Upper Extremity ◽

Peripheral Nerve Injuries ◽

Similar Function ◽

Nerve Injuries

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Chronic neuropathic pain after traumatic peripheral nerve injuries in the upper extremity: prevalence, demographic and surgical determinants, impact on health and on pain medication

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0111 ◽

2019 ◽

Vol 20 (1) ◽

pp. 95-108

Author(s):

Adriana Miclescu ◽

Antje Straatmann ◽

Panagiota Gkatziani ◽

Stephen Butler ◽

Rolf Karlsten ◽

...

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Peripheral Nerve ◽

Upper Extremity ◽

Nerve Injury ◽

Persistent Pain ◽

Peripheral Nerve Injuries ◽

Nerve Injuries ◽

Chronic Neuropathic Pain ◽

Younger Age

AbstractBackground and aimsAside from the long term side effects of a nerve injury in the upper extremity with devastating consequences there is often the problem of chronic neuropathic pain. The studies concerning the prevalence of persistent pain of neuropathic origin after peripheral nerve injuries are sparse. The prevalence and risk factors associated with chronic neuropathic pain after nerve injuries in the upper extremity were assessed.MethodsA standardized data collection template was employed prospectively and retrospectively for all patients with traumatic nerve injuries accepted at the Hand Surgery Department, Uppsala, Sweden between 2010 and 2018. The template included demographic data, pain diagnosis, type of injured nerve, level of injury, date of the lesion and repair, type of procedure, reoperation, time since the procedure, S-LANSS questionnaire (Self report-Leeds Assessment of Neuropathic Symptoms and Signs), RAND-36 (Item short form health survey), QuickDASH (Disability of Shoulder, Arm and Hand) and additional questionnaires concerned medication, pain intensity were sent to 1,051 patients with nerve injuries. Partial proportional odds models were used to investigate the association between persistent pain and potential predictors.ResultsMore than half of the patients undergoing a surgical procedure developed persistent pain. Prevalence of neuropathic pain was 73% of the patients with pain (S-LANSS ≥ 12 or more). Multivariate analysis indicated that injury of a major nerve OR 1.6 (p = 0.013), years from surgery OR 0.91 (p = 0.01), younger age OR 0.7 (p < 0.001), were the main factors for predicting pain after surgery. The type of the nerve injured was the strongest predictor for chronic pain with major nerves associated with more pain (p = 0.019).ConclusionsA high prevalence of chronic pain and neuropathic pain with a negative impact on quality of life and disability were found in patients after traumatic nerve injury. Major nerve injury, younger age and less time from surgery were predictors for chronic pain.

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