Outcome of Lower Limb Nerve Repair in a Tertiary Care Hospital
Abstract
Background: Lower extremity nerve trauma is less common than upper extremity nerve injuries1. Limited experience, concerns of prolonged healing times and average outcomes historically resulted in many lower limb nerve injuries being managed conservatively. Better understanding of nerve repair physiology, evaluation methods and microsurgical techniques have led to a lower threshold for surgical intervention.
Materials & Methods: Thirteen patients of lower extremity nerve injuries were managed at our reconstructive centre in a tertiary care hospital over a period of 5 years from 2012 to 2017. Data was compiled retrospectively from patient records and reviews. Six patients reported to us more than 1.5 yrs after the trauma and were excluded. Seven patients who underwent surgical intervention were included in this study and followed up for variable period of eight to eighteen months .
Results: All patients were male with an average age of 27.85 years (range 21 to 43 years). Four were injured due to gunshot wound (GSW) while the remaining three had injuries due to shell splinters, snake bite and road traffic accident . All except the snake bite case underwent exploration and debridement at local hospitals within hours of the trauma.In three cases the nerve injury was initially missed and detected subsequent to the acute event. Motor power examination as per Muscle Research Council (MRC) Grading System showed significant improvement in four cases. In one case of nerve graft there was no progression of Tinel’s sign and no motor recovery even after 7 months. Functional recovery in the form of running was achieved in four patients. Two patients could achieve satisfactory walking after tendon transfer and another with foot drop orthosis.
Conclusion: Lower limb nerve injury management by surgery is a promising option looking at the current scenario. Polytrauma victims in a mass casualty scenario may result in low priority handling of some peripheral nerve injuries. After patient recovery, early neurologic evaluation and low threshold for exploration is likely to yield optimal outcomes.
