One-Stage Reconstruction of Peripheral Neurovascular Gunshot Injuries in a Third World Country

Abstract

This study describes 45 young (mean age 38.5 years) male patients with firearm injuries who presented with vascular and neurologic lesions. A synchronous one-stage neurovas cular reconstruction was undertaken in these patients; 75.5% of the traumas involved the clavioaxillary region, producing 32 regional aneurysms (71.1%), 2 major vascular lacer ations (4.4%), and a high degree of neurotmesis (48.8%) and axonotmesis (26.7%) in the brachial plexus (BP). Lower limb vascular lesions included 5 aneurysms associated with significant regional neurotmesis. The follow-up rate was poor and declined from 100% at six weeks to 70.5% at one year and 22.7% at five years. Initial vascular patency rate of 95.5% at six weeks persisted throughout in a similar manner, but the declining reatten dance rate drastically reduced statistical reliability. Recovery to grade III or better was observed in 75% of nerve grafts in the BP region, with 89% of the neurolyzed nerves showing this improvement. The results in the lower limb were comparable. The main idea of presenting this study is to show a pattern that is typical of a third-world country with lack of financial resources, a poor patient-compliance, and peer bias.