Corresponding Author

Ayman Elsayed Galhom

Subject Area

Peripheral nerves, Trauma

Document Type

Original Study


Background Data: Peripheral nerve injuries (PNIs) by either gunshot missiles or shrapnel from barrel bomb explosions are common during war.

Purpose: This article aims to analyze the role and efficacy of movable field hospitals in managing penetrating peripheral limb injuries within a war zone area.

Study Design: Retrospective descriptive clinical case study.

Material and Methods: We studied the effect of penetrating PNIs from barrel bomb explosions on 25 (out of 30) patients of any age operated on during a period of 6 months in the Syrian civil war (between October 2012 and March 2013). Surgeries were done in field hospitals along the Syria–Turkey border, and surgeries ranged from neurolysis, end-to-end fascicular, and graft repair under general or local anesthesia.

Result: The mean age of the patients was 26.2 ± 7.4, and nearly all cases were males except for only one female. The most commonly affected nerve was the radial nerve (28%), followed by the common peroneal nerve (28%). Findings injuries were frequently found near to elbow or knee joints. Most of the injuries of victims (80%) were immediately repaired, and 20% were repaired weeks later after injury. Most cases had primary surgical repair of the nerve (64%), and two cases (8%) had repairs twice due to an infected wound and a lacerated nerve. The sural graft was done in 16%. Neuromas were found in 20% of cases. We were unable to follow up with all patients, and many patients were lost to follow-up. The most common complication was infection (12%). Complications were significantly related to wounds nearby joints (p=0.043) and associated bone or tendon injuries (p=0.012).

Conclusion: According to this study, shrapnel injury can cause serious nerve injuries similar to gunshot wounds. A movable field hospital near to war zone area can provide surgical management opportunities for nerve injuries in less critical patients. The most frequently affected site was near the elbow or knee joints. The effects of metal fragments detected near/or inside the nerve and long-term follow-up are major limitations in this study.


peripheral nerve injuries, field hospital, barrel bomb explosives, shrapnel