LOWER-EXTREMITY IATROGENIC NERVE INJURY DUE TO COMPRESSION DURING INTRAABDOMINAL SURGERY

BACKGROUND: iatrogenic nerve injury due to poor positioning and extern al compression is a common surgical complication. However, sciatic neu ropathy from external compression and femoral nerve injury after self- retaining retraction are less-published complications. METHODS: Surgic al Morbidity and Mortality Reports from 1986 through 1995 were reviewe d to identify femoral and sciatic neuropathies following intraabdomina l vascular and general surgeries. RESULTS: Two sciatic and 5 femoral n europathies were reported, an incidence of approximately 0.17% of abdo minal cases. Sciatic injuries were attributed to external compression, whereas femoral neuropathies were due to compression by self-retainin g retraction. The 3 female and 4 male patients had a mean age of 53.4 years, and no patient had a prior history of peripheral neuropathy. Me an operating time for sciatic injuries was 8.2 hours, versus 4.3 hours for femoral neuropathies. Both patients with sciatic neuropathy had c omplete resolution of symptoms, compared with 1 femoral neuropathy pat ient, Two femoral neuropathies were permanent, 1 had partial resolutio n and 1 had improvement at 4 months but was lost to follow-up. CONCLUS IONS: Sciatic and femoral compression neuropathies are rare but seriou s complications of abdominal surgery, When retracting in the deep pelv is, consideration should be given to using small, well-padded retracto r blades and repositioning these regularly, prevention of sciatic nerv e compression requires careful padding of the table surface, especiall y for longer cases. (C) 1997 by Excerpta Medica, Inc.