Tigre Joseph Yunga, Begera Mia, Errante Emily L, Burks S Shelby
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States.
Surg Neurol Int. 2024 Jan 12;15:10. doi: 10.25259/SNI_835_2023. eCollection 2024.
Gunshot wounds (GSWs) often result in neuropraxia or a mixed injury pattern rather than direct nerve transection. There is still debate between early and delayed intervention for the optimal treatment of intact nerves following GSWs. Early intervention may prevent the formation of dense scar tissue, and delayed intervention allows for the zone of injury to be fully demarcated for optimal treatment planning. Here, we present the case of a 29-year-old male who underwent exploration of the right common peroneal nerve after a GSW.
A 29-year-old male presented for evaluation of a GSW to the right lower extremity at the level of the fibular head he sustained 2 months prior. Following his injury, he was immediately evaluated in the emergency department and offered supportive care. He reported paresthesias in the right lower extremity and a right-sided foot drop. Computed tomography demonstrated a bullet fragment in the distal right lower extremity, and ultrasound revealed a partial thickness injury in the right peroneal nerve. Exploration of the right common peroneal nerve and bullet fragment was recommended. The bullet fragment was removed from the distal right lower extremity in one piece. Following this, the right common peroneal nerve was decompressed proximally to distally, with scar tissue encountered distally. Postoperatively, the patient did well, ambulating shortly after surgery, and at 3 weeks postoperative, he was ambulating without difficulty.
Clinical judgment and risk-benefit analysis of each patient must be made individually to determine the most optimal treatment method following GSWs.
枪伤（GSWs）常导致神经失用或混合性损伤模式，而非直接神经横断。对于枪伤后完整神经的最佳治疗，早期干预和延迟干预之间仍存在争议。早期干预可能预防致密瘢痕组织的形成，而延迟干预可使损伤区域得到充分界定，以制定最佳治疗方案。在此，我们报告一例29岁男性在枪伤后接受右侧腓总神经探查的病例。
一名29岁男性因2个月前在腓骨头水平遭受的右侧下肢枪伤前来评估。受伤后，他立即在急诊科接受评估并接受了支持性治疗。他报告右侧下肢感觉异常和右侧足下垂。计算机断层扫描显示右下肢远端有子弹碎片，超声显示右侧腓总神经有部分厚度损伤。建议对右侧腓总神经和子弹碎片进行探查。子弹碎片从右下肢远端完整取出。此后，对右侧腓总神经从近端到远端进行减压，在远端遇到瘢痕组织。术后，患者恢复良好，术后不久即可行走，术后3周时，他行走无困难。
必须对每位患者进行临床判断和风险效益分析，以确定枪伤后的最佳治疗方法。
