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Elective Peripheral Nerve Decompression After Burn Injury: Comparison of Patients With Electrical versus Non-Electrical Etiologies
C. Scott Hultman, MD, MBA; Cindy Wu, MD; C. Calvert; AA Meyer; BA Cairns
University of North Carolina, Chapel Hill, NC, USA
Purpose: Although neuropathy after burn injury may be multi-factorial, some patients with focal nerve compression benefit from surgical release. Few studies have examined the long-term outcomes of nerve decompression in this setting, and no studies have compared outcomes, based upon mechanism of injury. We present our experience with elective nerve decompression in burn patients and compare patients with electrical versus non-electrical etiologies.
Methods: From 2000-2010, we performed 236 elective nerve decompressions, at an accredited regional burn center, in 105 burn patients with peripheral neuropathy. We retrospectively reviewed prospectively collected data regarding demographics, mechanism, TBSA, NCV/EMGs, and timing/type of release performed. Outcome measures included complications, impairment rating, work status, and length of follow-up. Using Student’s T test and chi-square analysis, we compared patients with electrical injury to those whose etiology was due to thermal or chemical burns. Statistical significance was assigned to p values < 0.05.
Results: 105 patients (mean age 38.3 years, TBSA 18.4%) underwent 236 decompressions, a median of 382 days after thermal (72), electrical (26), chemical (7) injury. Tinel’s sign occurred in 78/105 exams, with abnormal NCV/EMG in 62/68 studies. Location of decompression included carpal tunnel (93), digital sheath (41), Guyon’s canal (45), cubital tunnel (34), proximal fibula (12), superficial radial nerve (5), antebrachial cutaneous nerve (5), and pronator tunnel (1). Complications included dehiscence (16), infection (10), hematoma (1), and nerve injury (1), for complication rates of 19.0% (by patient) and 8.5% (by site). 73 patients (69.5%) had definite improvement, 18 (17.1%) had minimal improvement, and 14 (13.3%) did not improve. Of 61 patients with workers’ compensation, 33 returned to work (mean impairment rating: 41%). Regarding etiology, we found no significant differences between patients with electrical versus non-electrical mechanisms, in terms of TBSA, timing/type of decompression, post-procedural improvement, complications, or persistent chronic pain. Patients with electrical injury were younger (32.3 vs 40.8 years, p<0.01), predominately male (96% vs 73%, p<0.05), had a higher incidence of workers’ compensation (80.8% vs 50.6%, p<0.01), were more likely to have a prior fasciotomy (42.3% vs 15.2%, p<0.01), had longer follow-up (681 vs 419 days, p<0.001), and trended toward more psychiatric disability (26.9% vs 11.4%, p=0.055).
Conclusion: Peripheral nerve decompression, even late after burn injury, is effective in treating nerve compression syndromes, especially in patients with electrical injury. Given the low morbidity and high potential for improvement, nerve release should be strongly considered as a therapeutic option in carefully selected burn patients.
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