Results of suture of the sciatic nerve after missile injury.

OBJECTIVE To evaluate functional recovery after suture of the sciatic nerve after missile injury. METHODS We reviewed the outcome of 23 adults and four children who had the sciatic nerve sutured above the knee 3 to 14 weeks after missile injury and who were followed for 14 to 36 months. RESULTS In adults, useful motor recovery was significantly better after suture of tibial (83%) than peroneal (39%) nerves, after suture of nerves at the thigh (71%) than at the buttock (31%) level, and after end-to-end anastomosis (74%) than grafting (39%). Useful sensory function was recovered in 78% of tibial nerves. Fifty-seven percent of adults walked wearing special shoes or pads. Significantly better recovery occurred in children, who all walked with normal footwear. CONCLUSION We advocate exploration of the sciatic nerve at any level within 3 months if no spontaneous recovery occurs after a missile injury. We do not advocate exploration of the sciatic nerve at the buttock level if only peroneal function is lost except in children.