Treatment of Sciatic Nerve Injuries

Introduction: Penetrating Sciatic nerve injuries are relatively rare, and management recommendations in the literature vary. We wish to report our experience with surgical neurolysis , direct suture and interposition nerve grafting in these challenging cases.

Methods: Data was retrospectively obtained from our hospital's electronic medical records. We included all patients treated for a peripheral nerve injury at the Hand Surgery Unit from December 2014 through July 2017. The demographic parameters and the diagnoses were collected. Both the general trauma treatment and the specific sciatic nerve injury were reviewed.

Results: Nine patients at an average age of 25 (7-55) were identified. Two patients were Israeli citizens and seven patients were casualties of the Syrian civil war.
Six patients had associated injuries and three had an isolated sciatic nerve lesion. The etiology was a gunshot injury in 5 patients, a blast injury in 2 and a stab injury in 2.
All patients underwent exploration. Two nerves were in continuity, 3 had a partial transection and 4 were completely transected. Surgery was performed at an average 8 (2-26) weeks from the injury. Two patients underwent neurolysis, two direct suture, and five sural nerve interposition grafting.
Median follow up was 2 weeks. None of the patients deteriorated from the neurological point of view. In all patients with either a continuous or a partially injured nerve we recorded a 2/5 motor improvement in the immediate postoperative period. One patient with a gluteal level injury recovered protective sensation over the sole of the foot after two years from the operation.

Conclusions: We recommend surgical exploration and repair of sciatic nerve early after the injury. In cases when the nerve is compressed or partially injured, motor improvement can be expected.