The role of a neurosurgeon in multidisciplinary treatment of combat peripheral nerve injury: strategy for limb function restoration in a municipal multidisciplinary hospital

   INTRODUCTION. Combat injuries of peripheral nerves occupy a significant place in the structure of modern surgical trauma. Phantom limb pain is a particular problem. Integration of military and civilian medicine is required in hospitals deployed on the basis of municipal institutions.

   AIM. To define the role of a civilian neurosurgeon in a multidisciplinary team of a hospital deployed on the basis of a municipal institution for the treatment of combat peripheral nerve injuries, with the goal of restoring limb function and preventing phantom limb pain.

   MATERIALS AND METHODS. Since August 2024, a specialized hospital for wounded servicemen has been operating on the basis of the St. Petersburg City Mariinsky Hospital (and continues to operate to this day). The study period covers August 2024 through December 2025. The neurosurgical department accounts for a quarter of the hospital’s bed capacity. Within the study, a multidisciplinary approach was implemented. The diagnostic algorithm included neurological examination, ENMG, ultrasound (performed jointly by a neurosurgeon and ultrasound specialist), validated pain scales (VAS, NRS), and the DN4 questionnaire.

   RESULTS. A significant number of wounded were treated, with the neurosurgical department accounting for 27 % of patients. Peripheral nerve lesions constituted 71 % of surgical interventions. More than 40 % of patients with PNS lesions required surgical treatment, with neurolysis (39.4 %), nerve suture (22.3 %), alcoholization or excision of neuromas (24.3 %), and foreign body removal (10.4 %) predominating in its structure. The rate of phantom limb pain was approximately 50 %. Surgical activity in the department reached 44.1 %. Postoperative complications amounted to 1.1 %. Mortality in the neurosurgical department was 0 %. More than half of the patients were discharged on sick leave.

   CONCLUSION. The model of a hospital deployed on the basis of a municipal institution is effective for managing combat peripheral nerve injuries. The multidisciplinary approach and low complication rate confirm the feasibility of this model.

1. Foreign Bodies Following Wounds and Injuries: Temporary Guidelines for Treatment and Military Medical Examination. Moscow: Ministry of Defense of the Russian Federation, Main Military Medical Directorate; 2023. 60 p. (In Russ.)

2. Howard I. M. et al. Combat-related peripheral nerve injuries: a systematic review of outcomes and rehabilitation strategies. Muscle Nerve. 2025;71(5):768–781. Doi: 10.1002/mus.28168.

3. Krylov V. V., Kordonsky A. Yu., Tanyashin S. V. et al. Key performance indicators of the neurosurgical service of the Russian Federation in 2024 (adult population). Neurosurgery. 2025;27(1):6–70. (In Russ.)

4. Gaivoronsky A. I., Svistov D. V., Kolomentsev S. V. et al. The concept of neurosurgical care for combat injuries of peripheral nerves. Bulletin of the Russian Military Medical Academy. 2024;26(4):627–638. (In Russ.) Doi: 10.17816/brmma634434. EDN: YWXGLM.

5. Gaivoronsky A. I., Svistov D. V., Isengaliev I. N. et al. Modern principles of care for combat injuries of peripheral nerves. Neurosurgery. 2025;27(2):130–141. (In Russ.) Doi: 10.63769/1683-3295-2025-27-2-130-141. EDN: GUSCKA.

6. Gaivoronsky A. I., Svistov D. V., Isaev D. M., Churikov L. I., Kim-Skaliychuk B. V. Modern interpretation of the classification of peripheral nerve injuries. Neurosurgery. 2025;27(1):106–111. (In Russ.) Doi: 10.24412/1683-3295-2025-27-1-106-111. EDN: MZVLSK.

7. A Thousand Days of the Special Military Operation. Selected Issues of Medical Support : monograph; eds by D. V. Trishkin. Moscow: Main Military Medical Directorate of the Ministry of Defense of the Russian Federation; 2024. 321 p. (In Russ.)

8. Kudyashev A. L., Khominets V .V., Nadulich K. A. Amputations in victims with combat surgical trauma : a textbook. St. Petersburg: S. M. Kirov Military Medical Academy; 2023. 72 p. (In Russ.)

9. Federal clinical guidelines for the prevention of phantom limb pain after limb amputation. Moscow: Federation of Anesthesiologists and Reanimatologists of the Russian Federation, Russian Society for the Study of Pain; 2014. 24 p. (In Russ.)

10. Kumar A., Soliman N., Gan Z., Cullinan P., Vollert J., Rice A.S.C., Kemp H. A systematic review of the prevalence of postamputation and chronic neuropathic pain associated with combat injury in military personnel. PAIN. 2024;165(4):727–740. Doi: 10.1097/j.pain.0000000000003094. EDN: CSGKEE.

11. Fayaz A., Croft P., Langford R.M., Donaldson L. J., Jones G. T. Prevalence of chronic pain in the UK : a systematic review and meta-analysis of population studies. BMJ Open. 2016;(6):e010364. Doi: 10.1136/bmjopen-2015-010364. EDN: WVTDGX.

12. Clinical guidelines – Chronic pain syndrome in adult patients requiring palliative care – 2023–2024–2025; approved by the Ministry of Health of the Russian Federation on 15.02.2023). ID: 400. (In Russ.)

13. Military Field Surgery. National Guidelines; eds by D. V. Trishkin, I. M. Samokhvalov. 2^nd ed. Moscow: GEOTAR-Media; 2024. 1056 p. (In Russ.)

14. Zhurbin E. A., Gaivoronsky A. I., Zheleznyak I. S., Dekan V .S., Churikov L. I., Alekseev E. D., Alekseev D. E., Svistov D. V. Diagnostic accuracy of ultrasound in injuries of peripheral nerves of the extremities. Bulletin of the Russian Military Medical Academy. 2017;19(3):63–68. (In Russ.) EDN: ZOWNJB.

15. Hawker G. A., Mian S., Kendzerska T., French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl. 11):S240–252. Doi: 10.1002/acr.20543.

16. Bouhassira D., Attal N., Fermanian J., Alchaar H., Gautron M., Masquelier E., Rostaing S., Lanteri-Minet M., Collin E., Grisart J. Development and validation of the neuropathic pain symptom inventory. Pain. 2004;108(3):248–257. Doi: 10.1016/j.pain.2003.12.024.

17. Tsivileva A. E., Trishkin D. V., Kryukov E. V. et al. Medical care for servicemen with limb amputations (surgical treatment, medical rehabilitation, prosthetics) : methodological recommendations. Version 2.0; eds by D. V. Kovlen. SPb.: S. M. Kirov Military Medical Academy; 2025. 127 p. (In Russ.)

18. Aytemirov Sh. M., Ostrovsky V. V., Bazhanov S. P. et al. The contribution of ultrasound to the assessment of traumatic peripheral nerve lesions: past, present and future. Russian neurosurgical journal named after professor A. L. Polenov. 2022;XIV(3):130–139. (In Russ.) Doi: 10.56618/20712693_2022_14_3_130. EDN: NGVCMP.