Management of Gunshot Injuries to Peripheral Nerves
Gunshot peripheral nerve injuries rarely exist in isolation. In this lecture, reconstructive microsurgeon Andrii Vysak explains how polystructural limb trauma, tissue loss, infection, ischemia, and compartment syndrome shape every reconstructive decision.
Drawing on experience from more than 2,300 patients with gunshot limb injuries, the session follows the pathway from debridement and fasciotomy to soft-tissue coverage, definitive bone fixation, and nerve reconstruction. Particular attention is given to ultrasound and needle EMG, the practical three-week-to-three-month window for reconstruction, neurolysis, nerve repair, autologous nerve grafting, distal nerve transfers, and tendon transfers—along with situations where the standard algorithm does not apply.
Clinical cases and discussion highlight difficult questions: why an anatomically intact nerve may still fail to recover, when VAC therapy becomes a liability, how the mesoneurium and lipofilling affect nerve gliding, and what rehabilitation can realistically change. A clinically dense session for surgeons who want to connect diagnostics, timing, and reconstructive strategy rather than treat the nerve as an isolated structure.
Drawing on experience from more than 2,300 patients with gunshot limb injuries, the session follows the pathway from debridement and fasciotomy to soft-tissue coverage, definitive bone fixation, and nerve reconstruction. Particular attention is given to ultrasound and needle EMG, the practical three-week-to-three-month window for reconstruction, neurolysis, nerve repair, autologous nerve grafting, distal nerve transfers, and tendon transfers—along with situations where the standard algorithm does not apply.
Clinical cases and discussion highlight difficult questions: why an anatomically intact nerve may still fail to recover, when VAC therapy becomes a liability, how the mesoneurium and lipofilling affect nerve gliding, and what rehabilitation can realistically change. A clinically dense session for surgeons who want to connect diagnostics, timing, and reconstructive strategy rather than treat the nerve as an isolated structure.