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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France

    Laurent Mathieu, James Charles Murison & Georges Pfister

  2. Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France

    Laurent Mathieu, James Charles Murison & Georges Pfister

  3. Military Biomedical Research Institute (IRBA), 1 place Général Valérie André, 91220, Brétigny-sur-Orge, France

    Laurent Mathieu

  4. Department of Orthopedic, Trauma and Hand Surgery, Edouard Herriot Hospital, 5 place d’Arsonval, 69003, Lyon, France

    Yannick Cloquell & Christophe Gaillard

  5. Nerve and Brachial Plexus Surgery Unit, Mont-Louis Private Hospital, 8 rue de la Folie Regnault, 75011, Paris, France

    Christophe Oberlin & Zoubir Belkheyar

Authors
  1. Laurent Mathieu
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  2. Yannick Cloquell
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  3. James Charles Murison
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  4. Georges Pfister
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  5. Christophe Gaillard
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  6. Christophe Oberlin
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  7. Zoubir Belkheyar
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Corresponding author

Correspondence to Laurent Mathieu.

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The authors declare that they have no conflict of interest, and no source of funding.

Supplementary Information

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Supplementary file1 Video, Supplemental Digital Content 1: Functional recovery at the last follow-up in Case 3 who presented with an 8-cm nerve defect at the mid-thigh level. (MP4 17751 kb)

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Mathieu, L., Cloquell, Y., Murison, J.C. et al. Defects of the sciatic nerve and its divisions treated by direct suturing in 90 degrees knee flexion: report on the first clinical series. Eur J Trauma Emerg Surg 48, 4955–4962 (2022). https://doi.org/10.1007/s00068-022-02034-6

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  • DOI: https://doi.org/10.1007/s00068-022-02034-6

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