Early surgical intervention in combat-related peripheral nerve injuries: Lessons from a consecutive cohort from the 2023-2024 Israel-Hamas war.

Abstract

Combat-related peripheral nerve injuries (CRPNIs) are frequently associated with significant long-term disability. While conventional practice often favors delayed exploration to avoid unnecessary interventions, emerging evidence supports early intervention. We retrospectively reviewed 184 patients (265 CRPNIs) treated during the first ten months of the 2023-2024 Israel-Hamas war. Collected data included demographics, injury details, surgical timing, intraoperative findings, procedures performed, and postoperative complications. Surgical Explorations were considered positive if partial/complete nerve transection or nerve compression (e.g., by shrapnel or bone fragment) were found. Of 184 patients, 136 (74%) underwent nerve exploration at a median of 8 days post-injury, with positive findings in 72% of these cases. Definitive nerve procedures (DNP), such as direct repair or graft reconstruction, were performed in 48% of explored cases, yielding a 5% perioperative complication rate. Early DNP recipients had significantly fewer secondary nerve procedures than those managed nonoperatively (19% vs. 38%, p=0.01). Early surgical exploration in CRPNIs demonstrated a high rate of actionable findings and reduced the subsequent need for surgical interventions, supporting a more aggressive initial approach. Further studies are warranted to determine long-term functional outcomes.