Sciatic nerve reconstruction: Limb preservation after sarcoma resection

Limb salvage for extremity sarcoma has become the standard of care when pos sible. This review attempts to determine the outcome of sciatic nerve recon struction after surgical tumor resection. The authors' objective was to det ermine the clinical value of extremity salvage with such a defect. Five pat ients (two male, three female) were selected from a department database at The University of Texas M.D, Anderson Cancer Center between 1995 and 1999 w ho met the following criteria: lower limb tumor resection involving a gap i n the sciatic nerve with subsequent nerve autograft reconstruction. An addi tional patient who underwent primary sciatic nerve neurorrhaphy was also in cluded. The average tumor size was 203 cm(2). The most common tumor histolo gy was spindle cell sarcoma. The average autograft length was 13 +/- 3.2 cm with one to four cables employed. Currently, 3 patients are still alive. F our of the 5 patients who received sciatic autonerve grafts reported partia l distal sensory recovery subjectively. The patient who underwent primary n eurorrhaphy has both motor and sensory innervation 42 months after surgery. Although not ideal for all patients, sciatic nerve reconstruction is a via ble option for those willing to undergo limb preservation. Notable limitati ons to daily activity do not appear to be present, and patients are able to ambulate with or without assistive devices. With aggressive rehabilitation , some patients are able to function quite well with this bioprosthesis, Pa tients should consider, however, that their extremity is on loan. Substanti al wound complications or infections may ultimately lead to amputation.