Abdallah Ibrahim E, Ayoub Rita, Sawaya Raja, Saba Salim C
Faculty of Medicine, American University of Beirut, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon.
Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020 Lebanon.
Patient Saf Surg. 2020 Oct 23;14:40. doi: 10.1186/s13037-020-00265-3. eCollection 2020.
Liposuction and autologous fat transplantation represent widely used techniques in plastic surgery to correct or enhance contour irregularities in the face and body. While these techniques are assumed to be safe, liposuction and fat grafting impose a hidden risk for serious preventable surgical complications and adverse patient outcomes. We hereby report two cases of iatrogenic sciatic nerve injury and provide recommendations on how to prevent this serious surgical complication.
We present two cases of sciatic nerve injury - one related to liposuction and the other related to gluteal lipo-augmentation. The first case is a 20-year-old female who presented to our institution with right leg weakness one week after undergoing scar revision and fat grafting in the left peri-oral region to correct peri-oral cicatricial banding and tissue atrophy. Fat was harvested from the medial thigh using a 3-mm cannula with low-pressure manual suction, utilizing minimal tumescent solution. Nerve conduction velocity and electromyography testing suggested a right-sided sciatic nerve lesion as a result of direct trauma. The patient was observed for a period of 4 months during which time she underwent physical therapy. At four months post-operatively, she had recovered completely. The second case is that of a 39-year-old female who presented to our institution with left-sided weakness of foot eversion and dorsiflexion five days after she had undergone liposuction of the thighs, flanks, and abdomen in addition to gluteal lipo-augmentation at an outside facility. The patient had undergone super wet liposuction in the areas of the abdomen, flanks and thighs. 200 mL of collected fat was then transplanted into each buttock at multiple levels. Post-operative computed tomography and electroneurography revealed acute left sided sciatic injury consistent with direct trauma to or compression of the sciatic nerve. The patient underwent an extensive regimen of physical therapy. Three months post-operatively, the patient had regained some motor function, but was lost to follow-up thereafter.
The sciatic nerve is relatively superficial and vulnerable to injury in the upper thigh and lower buttock regions. Therefore, extreme care should be taken when working in these areas to avoid direct or indirect injury to the sciatic nerve by compression or traction.
抽脂术和自体脂肪移植是整形外科中广泛应用的技术，用于矫正或改善面部和身体的轮廓不规则。虽然这些技术被认为是安全的，但抽脂术和脂肪移植会带来严重的可预防手术并发症和不良患者结局的潜在风险。我们在此报告两例医源性坐骨神经损伤病例，并就如何预防这种严重的手术并发症提供建议。
我们报告两例坐骨神经损伤病例——一例与抽脂术有关，另一例与臀部脂肪填充有关。第一例是一名20岁女性，在接受左侧口周区域瘢痕修复和脂肪移植以矫正口周瘢痕条索和组织萎缩一周后，出现右腿无力并前来我院就诊。使用3毫米套管通过低压手动抽吸从大腿内侧采集脂肪，使用的肿胀液极少。神经传导速度和肌电图测试表明，右侧坐骨神经损伤是直接创伤所致。对患者进行了4个月的观察，在此期间她接受了物理治疗。术后4个月，她已完全康复。第二例是一名39岁女性，在外部机构接受大腿、侧腹和腹部抽脂以及臀部脂肪填充五天后，出现左侧足部外翻和背屈无力并前来我院就诊。该患者在腹部、侧腹和大腿区域接受了超湿抽脂术。然后将200毫升采集的脂肪分多个层次移植到每个臀部。术后计算机断层扫描和神经电图显示急性左侧坐骨神经损伤，与坐骨神经直接创伤或受压一致。患者接受了广泛的物理治疗方案。术后三个月，患者恢复了一些运动功能，但此后失去了随访。
坐骨神经在大腿上部和臀部下部区域相对表浅且易受伤。因此，在这些区域操作时应格外小心，避免因压迫或牵引对坐骨神经造成直接或间接损伤。
