The optimal timing of surgical intervention for peripheral nerve injuries from gunshot wounds: A case series and systematic review.

The optimal timing of surgical intervention for peripheral nerve injuries (PNIs) after gunshot wounds (GSWs) is controversial. Although delayed intervention has traditionally been preferred, recent reports suggest earlier intervention may improve outcomes. This study compares early (≤ 3 months) versus delayed (> 3 months) surgical management of PNIs following GSWs. We retrospectively reviewed patients treated at a tertiary academic center between 2000 and 2023 who underwent surgical intervention for PNIs secondary to GSWs. A systematic review was conducted following PRISMA guidelines. PubMed, Embase, and Web of Science databases were searched for clinical studies reporting outcomes of PNIs after GSWs. A proportional meta-analysis was performed using a random-effects model. Fifteen patients (mean age of 38.3 years) underwent surgical intervention at a mean of 4.6 months post-injury. Seven patients were treated early, and 7 underwent delayed intervention. At follow-up, improvement in motor and/or sensory function was observed in 5 out of 7 early cases and 6 out of 7 delayed cases (p = 1.000). Eleven studies published between 1995 and 2023, involving 271 nerves, were included in the meta-analysis. Functional improvement occurred in 58.7% (n = 63) of patients in the early group and 70.7% (n = 208) in the delayed group. Pain relief was achieved in 100% of early and 74.4% of delayed cases. Both our institutional case series and proportional meta-analysis demonstrated similar rates of successful function and pain outcomes between early and delayed surgical intervention groups. Importantly, no additional harm was observed with early intervention, suggesting it is a safe and reasonable option in appropriately selected patients.