Results of Surgical Treatment of Peripheral Nerve Injuries of the Lower Extremities

Overview

Background.
This work presents the results of 48 operations in 48 patients with treatment of 48 nerves of the lower extremities in the course of 15 years from 1985 to 1999. The paper describes the basic trends of surgical treatment of different nerve injuries of the lower extremities.Material and methods. In 24 patients external neurolysis was performed, in 24 patients reconstruction operations were made. Reconstruction operations were made using suture of the peripheral nerve (10 patients) or more frequently (14 patients) by means of a nervous graft in tase of complete and persisting neurological deficiency and absence of action potentials during EMG. A complete or severe motor deficiency in the absence of spontaneous restoration in the course of several months (2-6) was an indication for surgery. Analysis of the effectiveness of surgery was done, depending on the following indicators: period which elapsed since surgery, patients age, type of injury, type of nerve injury, type of surgical intervention.Results. The best results were observed in external neurolyses. During the latter the least serious traumatic changes were treated. A useful grade of M3 and more was recorded in 22 patients (91.7%). Better results in reconstruction operations were observed in operations with sutues in 7 patients (70%) than when using a nervous graft which was used in treatment of the most serious nerve injuries associated with loss of nervous tissue. In those instances the results were late and the results were not always as expected. A usefizl grade of improvement was found in 4 patients (21.4%). Good and excellent results independent on the type of surgery, type and level of injury, interval after injury and the patients age were typical for the tibial nerve.Conclusion. Early surgical revision associated with neurolysis possibly reconstruction operation are in indicated cases very important.

Key words:
nerve lesions of the lower extremities - neurolysis - nerve suture - nervous graft.