Modern principles of medical treatment for combat injuries of peripheral nerve

The Department of Neurosurgery of the S. M. Kirov Military Medical Academy has developed and implemented a new concept for providing assistance to the wounded with injuries to peripheral nerves. During previous military conflicts, wait-and-see tactics for treating such victims were standard. Reconstructive interventions on nerves were performed no earlier than 3–6 months after injury. This was justified by the fact that impaired nerve function is often associated with a contusion mechanism and restoration of conductivity could occur without surgery. In recent years, neuroimaging methods such as magnetic resonance neurography and ultrasound examination of peripheral nerves have been actively developed at the Military Medical Academy. Their use (immediately upon achieving healing of the surgical wound after primary surgical treatment, and for magnetic resonance neurography – after removal of metal foreign bodies), in addition to electroneuromyography, which is not always informative in the early stages, but traditionally used, makes it possible to confirm or exclude a complete anatomical break of the nerve trunk and determine the pathomorphological form of its damage. While maintaining the morphological integrity of the nerve, the wounded person is prescribed adequate conservative (neurotrophic, analgesic) therapy. In the presence of pathomorphological changes, reconstructive surgical interventions on peripheral nerves are now carried out in the early stages after injury (3–6 weeks). The sooner reconstructive intervention on the nerve is performed, the greater the likelihood and the faster its function will be restored. The most important element of the new concept of providing care to patients with peripheral nerve injuries is close interaction between neurosurgeons and neurologists, ensuring continuity of care at all stages of treatment. Firstly, it made it possible to timely identify patients with clinical signs of damage to the peripheral nervous system in the flow of incoming surgical patients. Secondly, it has proven its effectiveness in the treatment of neuropathic pain syndrome in this category of patients at the stage before and after neurosurgical intervention. Thirdly, early reconstructive intervention is followed by early restorative treatment under the supervision of a neurologist.