On the issue of modern classification of peripheral nervous system's combat injuries

Abstract

Combat injuries to the peripheral nervous system are of particular interest because they differ significantly from peacetime nerve injuries and, accordingly, require a different approach to their classification and diagnosis. They are also characterized by a slightly different algorithm of diagnostic measures and treatment tactics. This problem is relevant not only for military surgeons, since gunshot wounds to nerves are not uncommon in peacetime. The leading position in the structure of mine-explosive wounds is traditionally occupied by limb wounds, but cases of damage to cranial nerves are not uncommon. Combat injuries are often characterized by significant damage to soft tissues, main vessels, nerve trunks and bone structures. Among the features of the clinical course of such nerve injuries, a higher frequency of causalgia, as well as a neurological deficit caused by the presence of an intraneural foreign object or due to compression of an intact nerve trunk by a conglomerate of cicatricial tissues, can be highlighted. Traditionally, nerve injuries both in wartime and in peacetime are characterized by a high degree of disability of the victims, which is reflected in a decrease in the quality of life. Available domestic and foreign literature has a significant number of classifications of peacetime injuries to the peripheral nervous system and only isolated mentions of the classification of combat injuries. The lack of a single classification approach to this nosology significantly complicates a multidisciplinary approach in the treatment of such wounded due to the fact that the diagnosis of clinicians of related specialties often differs from the neurosurgical one. In turn, this is reflected in the choice of the wrong treatment tactics and, accordingly, in a decrease in its effectiveness. In this paper, the authors propose an improved modern classification of combat injuries to the peripheral nervous system, based on previously put forward, as well as on the experience of treating nerve injuries in the neurosurgery clinic of the S.M. Kirov Military Medical Academy.