Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XX: Wounds and Injuries of Peripheral Nerves

Sharply Transected Neural Elements

United States Department of Defense

Historically, close to 40% of nerve injuries cared for by the military during war have not been directly related to combat. These represent clean-cut transections of nerves by glass or sharp metal edges. These should be definitively repaired at an early date. Soft-tissue wounds due to sharp injuries and associated with complete paralysis of one or more nerves need to be closed in any case. If, during such closure, the sharply transected and noncontused nerve stumps with neatly divided epineurium are located, there may be some advantage to acute (primary) repair. Stumps will not have had time to retract, anatomy is straightforward, and a repair under minimal tension can be readily carried out. The surgeon must have had some experience with nerve repair. The necessary instruments include magnification Loupes, a bipolar coagulator, and 6-0 suture. The surgeon should be willing and able to take the time to do a careful repair. Acute repair of transected elements is of special value for sharp transections of brachial plexus elements and the sciatic nerve where delay and secondary repair oftentimes require the use of nerve grafts because of stump retraction and scar formation.

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Operational Medicine 2001

Health Care in Military Settings

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