Disclosures: Matthew R. Kelly, MD: Nothing to disclose

Case Description: Intra-operatively, during total hip arthroplasty, the patient was found to have an avulsion-type transection of her right sciatic nerve. Plastic surgery performed an immediate primary end-to-end nerve repair. Noted to be under significant tension, the repair dehisced. 5 days later, cable-graft reconstruction using the ispsilateral sural and superficial peroneal nerves was done. The patient was discharged to acute rehab and progressed well in therapy, demonstrating improved independence, albeit without active range of motion (AROM) of her right ankle, less than anti-gravity knee-flexion and persistent foot numbness. To restore ankle plantarflexion (with synergistic knee extension), she subsequently underwent nerve transfer from 2 vastus medialis-destined motor branches to the medial and lateral heads of her gastrocnemius using grafts from the residual sural and posterior femoral cutaneous nerves.

Setting: Acute Rehabilitation Hospital.

Patient: 57-year-old woman, post-nerve reconstruction and transfer following intra-operative sciatic nerve avulsion.

Assessment/Results: 8 months after nerve transfer, the patient remains in physical therapy and demonstrates improved ambulation with functional knee-flexion. She continues to lack AROM below the ankle, however recovery of plantarflexion is not expected earlier than 1-year post-op given her anticipated rate of axonal regeneration.

Discussion: Iatrogenic sciatic nerve injuries are rare, but may occur after nerve blocks, injections, and hip surgeries. Complete avulsion injuries with high sciatic nerve repair often result in unsatisfactory outcomes, however novel surgical approaches and structured rehabilitation programs have led to more favorable results

Conclusion: Tendon and nerve transfers are an option for some patients and successful reanastomosis, as in our case, may restore motor function. In this patient, due to the high level of injury and rate of axonal regeneration, the motor endplates responsible for ankle motion may degenerate prior to potential reinnervation. Only with time will we be able to assess for a successful functional reinnervation of her plantarflexors. Given the positive trajectory thus far, we remain hopeful.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nerve-transfer-to-restore-ankle-plantarflexion-after-iatrogenic-sciatic-nerve-avulsion-a-case-report/