FEMORAL NEUROPATHY SECONDARY TO THE USE OF A SELF-RETAINING RETRACTOR- REPORT OF 3 CASES AND REVIEW OF THE LITERATURE

PURPOSE: Three recent cases of femoral neuropathy at our institution f ollowing colorectal surgery have been ascribed to the use of the self- retaining Bookwalter(TM) retractor. The pathophysiology of neural inju ry includes compression, stretch, transection, Ligation, iliopsoas hem atoma, ischemia, and cement encapsulation. The aim of this study is to provide a comprehensive review of femoral nerve anatomy and mechanism of retractor injury. METHODS: The relationship of the femoral nerve t o the lateral blade of the Bookwalter(TM) retractor was evaluated duri ng colorectal surgery and in cadaveric dissections. RESULTS: The later al blade of the self-retaining retractor was observed to either compre ss or impinge the intrapelvic portion of the femoral nerve. CONCLUSION : The incidence of postoperative femoral neuropathy is likely underest imated because a majority of cases are self-limited. This debilitating iatrogenic injury can be prevented with a thorough understanding of f emoral nerve anatomy and careful placement of self-retaining retractor blades.