SVIBOR - Project code: 3-01-506

MINISTRY OF SCIENCE AND TECHNOLOGY

Strossmayerov trg 4, HR - 10000 ZAGREB
tel.: +385 1 459 44 44, fax: +385 1 459 44 69
E-mail: ured@znanost.hr

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Project code: 3-01-506


MICROSURGICAL TREATMENT OF THE PERIPHERAL NERVE INJURIES


Main researcher: STANEC, ZDENKO (54660)


Assistants
Type of research: applied
Duration from: 02/04/92. to 09/01/96.
Papers on project (total): 12
Papers on project quoted in Current Contents: 4
Institution name: Medicinski fakultet, Zagreb (108)
Department/Institute: INSTITUTE OF PLASTIC SURGERY DEPARTEMENT OF SURGERY, CLINICAL HOSPITAL DUBRAVA SCHOOL OF MEDICINE, UNIVERSITY OF ZAGREB
Address: Avenija izviđaća 6,10000 Zagreb
City: 10000 - Zagreb, Croatia
Communication
Phone: 385 (0) 1 28 74 44 lok.2570
Fax: 385 (0) 1 26 36 95
Fax: 385 (0)
Summary: Reconstruction of wounds including soft-tissue defect and exposed or even injured bone, blood vessel, peripheral nerve or tendon is a common problem in plastic surgery. Peacetime experience in the management of gunshot injuries is rather different from that of war surgery. Understanding of the pathophysiology of war wounds, caused mainly by high-energy missiles is important for choosing the best type of surgical treatment. The main goals of the first part of our scientific research were: 1.) using microsurgical technique , to define the extent of primary excision that is adequate for early reconstruction 2.) to find out which is the most adequate time for definitive reconstruction 3.) to choose the most appropriate reconstructive procedure for definitive reconstruction As war operations in Croatia slovely diminished, the number of wounded persons that required secondary reconstruction of injured peripheral nerves exceeded the number of patients with acute injuries. According to available literature and our own clinical experience, 70% of war wounds affected extremities and incidence of associated peripheral nerve injuries was about 20%. Taking into consideration the incidence of spontaneous recovery ( in 70% of peripheral nerve injuries caused by war weapons ) and present data about the number of wounded persons in Croatia, we can expect that more than 1000 wounded persons with peripheral nerve injuries would require surgical procedure. Such impressive number of patients with injured peripheral nerves, as well as the complexity of their treatment point out to a necessity of scientific approach to this problem. That led us to precise study of pathology and treatment of injured peripheral nerves in continuance of our research. Expected advancement from this scientific research would be to determine the optimal time for surgical procedure, as well as the most appropriate microsurgical technique for peripheral nerve reconstruction. Achievement of the improved nerve reconstruction will result in significantly shorter duration of hospital stay, and lead to more effective rehabilitation and recovery of the patients.

Keywords: war wounds, microsurgical reconstruction, peripheral nerve injury, proper nerve repair

Research goals: GOALS 1. To determine the proper timing of nerve repair. 2. To determine the exact part of injured nerve that should beexcised before repair of gunshot or explosive nerve injuries. 3. To determine the most successful microsurgical technique fornerve repair. 4. To determine the time within complete spontaneous recovery ofgunshot or explosive nerve injuries can occur. EXPECTED RESULTS As there are no scientific proofs about proper timing of nerverepair of injuries caused by high-energy missiles, the results ofthis research would advance understanding of the nervepathophysiology and regeneration in management of peripheralnerve war injuries. It is also necessary to find out the adequateextent of resection of the peripheral nerve stumps before therepair because that determines the microsurgical technique ofnerve repair as well as the presence and advancement of recovery.Huge number of nerve injuries of this type will allow us to judgethe success of various microsurgical techniques of nerve repair.Till today they have been compared on a small number of clinicalcases, and therefore adequate scientific conclusions could notbeen found. To determine the time within the complete spontaneousrecovery of gunshot or explosive nerve injuries can occur, iscrucial for creating the protocol of treatment of this injuries.We expect that the results of our research will improve theunderstanding of the peripheral nerve regeneration and achieve animportant progress in dealing with the problem of therapeuticapproach to this problem. Evaluation of first results forced us to add two more goals; 5. To determine the success of secondary peripheral nerve reconstruction 24 months or more after failed primary surgery, 6. To evaluate the success of palliative procedures and their improvement on extremity function.
Other information about the project.
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Last update: 10/09/95
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