Management of Sciatic Nerve Defects

Abstract Management of sciatic nerve injuries can be difficult for surgeons without a special interest in nerve surgery as they would only treat a handful of such cases for many years. Sciatic nerve defects pose the greatest repair challenges, with nerve grafting producing mixed results because of the large size of the nerve in both diameter and length. This article first presents the peculiarities of sciatic nerve defects management, based on the authors experience and a literature review. Various issues are dealt with: When to operate depending on the injury mechanism? What are the results of nerve autografting and allografting? On which component should the repair focus in very large defects? Subsequently, alternatives to conventional nerve grafting are proposed. The authors stress the usefulness of direct nerve suture with knee flexion at 90 degrees, which permits bridging of gaps as much as 8 cm in length. For larger defects, other procedures should be considered: long vascularized nerve grafting in complete lesions, short grafting with knee flexed, or tendon transfers in partial lesions.

[1]  C. Oberlin,et al.  Missile Injury of the Sciatic Nerve: Observational Study Supporting Early Exploration and Direct Suture With Flexed Knee. , 2019, Military medicine.

[2]  S. Alqassab,et al.  Sniper-induced sciatic nerve injury , 2019, Journal of the Royal Army Medical Corps.

[3]  C. Oberlin,et al.  Direct suturing of sciatic nerve defects in high-degree knee flexion: an experimental study. , 2019, World neurosurgery.

[4]  Depeng Meng,et al.  Translocation of the soleus muscular branch of the tibial nerve to repair high common peroneal nerve injury , 2019, Acta Neurochirurgica.

[5]  Ioannis P. Kostas-Agnantis,et al.  Current concepts in peripheral nerve surgery , 2018, European Journal of Orthopaedic Surgery & Traumatology.

[6]  M. Landau,et al.  Combat Injury of the Sciatic Nerve - An Institutional Experience. , 2018, Military medicine.

[7]  L. Head,et al.  Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis , 2018, Journal of Reconstructive Microsurgery.

[8]  S. Ferris,et al.  Partial tibial nerve transfer to tibialis anterior for traumatic peroneal nerve palsy , 2017, Microsurgery.

[9]  G. Buncke,et al.  Autograft Substitutes: Conduits and Processed Nerve Allografts. , 2016, Hand clinics.

[10]  F. Leclère,et al.  Nerve Transfers for Persistent Traumatic Peroneal Nerve Palsy: The Inselspital Bern Experience. , 2015, Neurosurgery.

[11]  S. Lepreux,et al.  [Sciatic nerve intraneural perineurioma]. , 2015, Annales de pathologie.

[12]  Theodore A Kung,et al.  Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration , 2014, Journal of Orthopaedic Surgery and Research.

[13]  A. Levi,et al.  Challenges in sciatic nerve repair: anatomical considerations. , 2014, Journal of neurosurgery.

[14]  Karl M. Schweitzer,et al.  Tendon transfers for the drop foot. , 2014, Foot and ankle clinics.

[15]  M. Hogan,et al.  Peripheral nerve repair and reconstruction. , 2013, The Journal of bone and joint surgery. American volume.

[16]  H. Simmen,et al.  Direct nerve suture and knee immobilization in 90° flexion as a technique for treatment of common peroneal, tibial and sural nerve injuries in complex knee trauma , 2012, Journal of surgical case reports.

[17]  Renata V Weber,et al.  Functional outcome following nerve repair in the upper extremity using processed nerve allograft. , 2012, The Journal of hand surgery.

[18]  C. Oberlin,et al.  Gunshot injuries to the nerves. , 2011, Chirurgie de la main.

[19]  D. Dahm,et al.  Surgical treatment of peroneal nerve palsy after knee dislocation , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[20]  J. Gousheh,et al.  Therapeutic Results of Sciatic Nerve Repair in Iran-Iraq War Casualties , 2008, Plastic and reconstructive surgery.

[21]  H. Seçer,et al.  The clinical, electrophysiologic, and surgical characteristics of peripheral nerve injuries caused by gunshot wounds in adults: a 40-year experience. , 2008, Surgical neurology.

[22]  P. Soucacos,et al.  Sciatic and peroneal nerve injuries , 2006, Microsurgery.

[23]  Z. Roganović Missile-Caused Complete Lesions of the Peroneal Nerve and Peroneal Division of the Sciatic Nerve: Results of 157 Repairs , 2005, Neurosurgery.

[24]  Daniel H. Kim,et al.  Management and outcomes in 353 surgically treated sciatic nerve lesions. , 2004, Journal of neurosurgery.

[25]  Daniel H. Kim,et al.  MANAGEMENT AND OUTCOMES IN 318 OPERATIVE COMMON PERONEAL NERVE LESIONS AT THE LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER , 2004, Neurosurgery.

[26]  L. Sedel The surgical management of nerve lesions in the lower limbs clinical evaluation, surgical technique and results , 2004, International Orthopaedics.

[27]  J. Tsuruda,et al.  Intraneural perineurioma of the common peroneal nerve. Case report and review of the literature. , 2001, Journal of neurosurgery.

[28]  C B Novak,et al.  Clinical Outcome following Nerve Allograft Transplantation , 2001, Plastic and reconstructive surgery.

[29]  M. Samardžić,et al.  Missile injuries of the sciatic nerve. , 1999, Injury.

[30]  J. Taha,et al.  Results of suture of the sciatic nerve after missile injury. , 1998, The Journal of trauma.

[31]  Daniel H. Kim,et al.  Management and results of sciatic nerve injuries: a 24-year experience. , 1998, Journal of neurosurgery.

[32]  J. Comtet,et al.  [Vascularized nerve trunk grafts. Technic and results of 27 cases]. , 1989, Annales de chirurgie de la main : organe officiel des societes de chirurgie de la main.

[33]  A. Berger,et al.  The Interfascicular Nerve-grafting of the Median and Ulnar Nerves , 1972 .

[34]  A. Carayon,et al.  Dual transfer of the posterior tibial and flexor digitorum longus tendons for drop foot. Report of thirty-one cases. , 1967, The Journal of bone and joint surgery. American volume.

[35]  P. Bourrel,et al.  [Suture of the sciatic nerve performed 15 months after its section. Result 2 years later. Value of repeated exploration]. , 1966, Annales de chirurgie.