Summary of - Delayed Presentation of Sciatic Nerve Injury with Gap A Case Report with a Unique Solution from the Past

Document Type

Article

Abstract

Case-

A 35-year-old farmer had a left-side flail foot and an infected foot ulcer. He had a history of an assault injury. Scar over the lateral aspect of thigh headed by secondary intention. Active knee and hip movements showed a grading of 4. Ultrasonography showed a complete transaction of the sciatic nerve with a midthigh neuroma. Radiographs showed no osteomyelitis. Electrodiagnostic studies confirmed sciatic neuropathy.

Treatment-The patient initially underwent debridement and saucerization of the ulcer (Wagner 1)

Procedure- St. Claire Strange procedure with minor modification

Stage 1(After 1 month of ulcer debridement)- Sciatic nerve exploration. Intraoperatively, neuroma of the sciatic nerve was found at midthigh with a gap of 10 cm from the distal glioma which was 3 cm from the popliteal crease. Sciatic nerve was dissected and separated into the PTN and CPN components, freshened, and coapted epineurally.

Stage 2(6 weeks later)- the CPN (coapted now to the PTN) was re-explored distally and divided 3 cm beyond its bifurcation and flipped proximally to bridge the gap which now measured 11 cm. We were able to achieve epineural coaptation without any tension after confirming healthy bleeding at the new distal stump.Patient at this stage also underwent Campbell’s posterior bone block procedure ,involving a fibula strut graft and fixation with screws.

Result-

After a 5-week non-weightbearing period, the patient was mobilized with an ankle-foot orthosis. After 3 months, the ulcer healed, and the patient resumed routine work. At 5 years, no recurrence of the ulcer or foot deformity was observed, and the patient could perceive minimal movement at the subtalar joint.

Conclusion-

Staged pedicled peroneal nerve grafting with a posterior bone block procedure is a viable solution for very large sciatic nerve defect with predictable results.

Publication date- 2022

Publication Date

2022

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