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European Journal of Trauma and Emergency Surgery

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20-07-2022 | Nerve Injury | Original Article

Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series

Authors: Laurent Mathieu, Yannick Cloquell, James Charles Murison, Georges Pfister, Christophe Gaillard, Christophe Oberlin, Zoubir Belkheyar

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2022

Abstract

Objective

To evaluate functional results after treatment of large defects of the sciatic nerve and its divisions by direct nerve suturing in high knee flexion.

Methods

A retrospective review was conducted in patients treated for lower extremity nerve defects between 2011 and 2019. Inclusion criteria were a defect > 2 cm with a minimal follow-up period of 2 years for the sciatic nerve and 1 year for its divisions. Nerve defects were bridged by an end-to-end suture with the knee flexed at 90° for 6 weeks. Functional results were assessed based on the Medical Research Council’s grading system.

Results

Seventeen patients with a mean age of 27.6 years were included. They presented with seven sciatic nerve defects and ten division defects, including eight missile injuries. The mean time to surgery was 12.3 weeks and the mean nerve defect length was 5 cm. Overall, 21 nerve sutures were performed, with eight in the tibial distribution and 13 in the fibular distribution. Post-operatively, there was no significant knee stiffness related to the immobilization. The mean follow-up time was 24.5 months. Meaningful motor and sensory recovery were observed after 7 of 8 sutures in the tibial distribution and 11 of 13 sutures in the fibular distribution. A functional sural triceps muscle with protective sensibility of the sole was restored in all patients. There were no differences according to the injury mechanisms.

Conclusion

Temporary knee flexion at 90° allows for direct coaptation of sciatic nerve defects up to 8 cm, with promising results no matter the level or mechanism of injury.

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Kline DG, Kim D, Midha R, Harsh C, Tiel R. Management and results of sciatic nerve injuries: a 24-year experience. J Neurosurg. 1998;89:13–23.CrossRefPubMed

Samardzić MM, Rasulić LG, Vucković CD. Missile injuries of the sciatic nerve. Injury. 1999;30:15–20.CrossRefPubMed

Kim DH, Murovic JE, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg. 2004;101:8–17.CrossRefPubMed

Kim DH, Murovic JE, Tiel R, Kline DG. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. J Neurosurgery. 2004;54:1421–8.CrossRef

Roganovic Z. Missile-caused complete lesions of the peroneal nerve and peroneal division of the sciatic nerve: results of 157 repairs. Neurosurg. 2005;57:1201–12.CrossRef

Gousheh J, Arasteh E, Beikpour H. Therapeutic results of sciatic nerve repair in Iran-Iraq War casualties. Plast Reconstruct Surg. 2008;121:878–86.CrossRef

Mathieu L, Pfister G, Murison JC, Oberlin C, Belkheyar Z. Missile injury of the sciatic nerve: observational study supporting early exploration and direct suture with flexed knee. Mil Med. 2019;184:e937–44.CrossRefPubMed

Mathieu L, Alqassab S, Fakhi RM. Sniper-induced sciatic nerve injury. BMJ Mil Health. 2020;166:210.CrossRefPubMed

Iordache SD, Gorski A, Nahas M, Feintuch L, Rahamimov N, Rutenberg TF. Treatment of peripheral nerve injuries in Syria’s war victims: experience from a northern Israeli hospital. Isr Med Assoc J. 2021;23:279–85.PubMed

10.

Korompilias AV, Payatakes AH, Beris AE, Vekris MD, Afendras GD, Soucacos PN. Sciatic and peroneal nerve injuries. Microsurgery. 2006;26:288–96.CrossRefPubMed

11.

Sedel L. The surgical management of nerve lesions in the lower limbs. Clinical evaluation, surgical technique and results. Int Orthop. 1985;9:159–70.CrossRefPubMed

12.

Millesi H. Lower extremity nerve lesions. In: Terzis JK, editor. Micro-reconstruction of nerve injuries. Philadelphia: W.B. Saunders; 1987. p. 239–51.

13.

Matejcik V. Surgical treatment of fibular nerve injury [in Czech]. Rozhl Chir. 2001;80:397–401.PubMed

14.

Gürbüz Y, Sügün TS, Ozaksar K, Toros T, Ademoğlu Y. Peroneal nerve injury surgical treatment results. Acta Orthop Traumatol Turc. 2012;46:438–42.CrossRefPubMed

15.

Jones PE, Meyer M, Faillace WJ, et al. Combat injury of the sciatic nerve–an institutional experience. Mil Med. 2018;183:e434–41.CrossRefPubMed

16.

Burks SS, Levi DJ, Hayes S, Levi AD. Challenges in sciatic nerve repair: anatomical considerations. J Neurosurg. 2014;121:210–8.CrossRefPubMed

17.

Oberlin C, Rantissi M. Gunshot injuries to the nerves. Chir Main. 2011;30:176–82.CrossRefPubMed

18.

Mathieu L, Addas BMJ, Irimura SC, Oberlin C, Belkheyar Z. Management of sciatic nerve defects: lessons learned and proposal for a new strategy. Ann Plast Surg. 2020;84:559–64.CrossRefPubMed

19.

Dunn JC, Tadlock J, Klahs KJ, Narimissaei D, McKay P, Nesti LJ. Nerve reconstruction using processed nerve allograft in the U.S. Military Mil Med. 2021;186:e543–8.CrossRefPubMed

20.

Bourrel P. Favorable results of sciatic nerve suturing performed 15 months after sectioning. Value of repeated exploratory surgery 2 months after the suturing. Mars Chir. 1965;17:203–8.PubMed

21.

Bourrel P, De Bisschop G. Suture of the sciatic nerve performed 15 months after its section. Result 2 years later. Value of repeated exploration. Ann Chir. 1966;20:1145–9.PubMed

22.

Döring R, Ciritsis B, Giesen T, Simmen HP, Giovanoli P. 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. JSCR. 2012. https://doi.org/10.1093/jscr/rjs019.CrossRefPubMedPubMedCentral

23.

Mathieu L, Achour S, Oberlin C, Belkheyar Z. Single versus double tendon transfer for foot drop due to post-traumatic common fibular nerve palsy. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/s00068-021-01602-6.CrossRefPubMed

24.

Pfister G, Ghabi A, de Carbonnières A, Oberlin C, Belkheyar Z, Mathieu L. Direct suturing of sciatic nerve defects in high-degree knee flexion: an experimental study. World Neurosurg. 2020;133:e288–92.CrossRefPubMed

25.

Medical research council of the United Kingdom. 1976 Aids to the examination of peripheral nervous system. London, Her Majesty’s Stationery Office

26.

Taha A, Taha J. Results of suture of the sciatic nerve after missile injury. J Trauma. 1998;45:340–4.CrossRefPubMed

27.

Hou C, Wang S, Chen A, Zhang W, Kuang Y, Liu Y, et al. Surgical management for sciatic nerve injury. Chin J Traumatol. 2002;5:338–41.PubMed

28.

Millesi H. The interfascicular nerve grafting of the median and the ulnar nerves. J Bone Joint Surg Am. 1972;54:727–50.CrossRefPubMed

29.

Millesi H. Factors affecting the outcome of peripheral nerve surgery. Microsurgery. 2006;26:295–302.CrossRefPubMed

30.

Ho B, Khan Z, Switaj PJ, et al. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration. J Orthop Surg Res. 2014;9:67.CrossRefPubMedPubMedCentral

31.

Lingaiah P, Jaykumar K, Sural S, Dhal A. Functional evaluation of early tendon transfer for foot drop. J Orthop Surg (Hong Kong). 2018;26:2309499018799766.CrossRefPubMed

Title: Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series
Authors: Laurent Mathieu
Yannick Cloquell
James Charles Murison
Georges Pfister
Christophe Gaillard
Christophe Oberlin
Zoubir Belkheyar
Publication date: 20-07-2022
Publisher: Springer Berlin Heidelberg
Keywords: Nerve Injury
Nerve Suture
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02034-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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