A Systematic Review and Meta-Analysis on the Timing of Surgical Intervention for Peripheral Nerve Injuries from Gunshot Wounds

Introduction: The optimal timing of surgical intervention for peripheral nerve injuries (PNIs) after gunshot wounds (GSWs) has remained a topic of debate. Traditionally, delayed surgical intervention has been the preferred approach as it gives time for spontaneous recovery and improved demarcation of the injury zone. However, recent reports have emphasized earlier intervention. In this study, we compare the outcomes of early and delayed surgical intervention for PNIs from GSWs.

Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and Web of Science databases were searched for clinical articles on PNIs related to GSWs. Search terms included peripheral nerve injury [Mesh] and gunshot [Mesh]. Full-text articles evaluating surgical outcomes from PNIs following GSWs were included.

Results: Eleven studies, published between 1995 and 2023, assessing 271 nerves that underwent surgical intervention for GSW-injury were identified from 411 screened articles. Of these injuries, 63 underwent early intervention (<= 3 months post-injury), while 208 underwent delayed intervention (> 3 months). Since the included studies utilized a variety of scales to assess pain and function, a proportional meta-analysis was performed. The analysis revealed that 58.7% (n=63) of patients in the early group and 70.7% (n=208) in the delayed group demonstrated significant functional improvement. Similarly, all patients (100%, n=15) in the early intervention group and 74.4% of patients (n=43) in the delayed intervention group showed meaningful improvement in pain.

Conclusion : Similar rates of successful function and pain outcomes were observed between early and delayed surgical intervention groups. With no detriment in early intervention, early surgical management may be considered for patients, as it may mean a faster return to activities of daily living. Nevertheless, larger studies with long-term follow-up of PNIs from GSWs are needed to better define the optimal timing of surgical intervention.