Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
J Surg Oncol. 2021 Jul;124(1):33-40. doi: 10.1002/jso.26487. Epub 2021 Apr 8.
Advances in the care of soft-tissue tumors, including imaging capabilities and adjuvant radiation therapy, have broadened the indications and opportunities to pursue surgical limb salvage. However, peripheral nerve involvement and femoral nerve resection can still result in devastating functional outcomes. Nerve transfers offer a versatile solution to restore nerve function following tumor resection.
Two cases were identified by retrospective review. Patient and disease characteristics were gathered. Preoperative and postoperative motor function were assessed using the Medical Research Council Muscle Scale. Patient-reported pain levels were assessed using the numeric rating scale.
Nerve transfers from the obturator and sciatic nerve were employed to restore knee extension. Follow up for Case 1 was 24 months, 8 months for Case 2. In both patients, knee extension and stabilization of gait without bracing was restored. Patient also demonstrated 0/10 pain (an average improvement of 5 points) with decreased neuromodulator and pain medication use.
Nerve transfers can restore function and provide pain control benefits and ideally are performed at the time of tumor extirpation. This collaboration between oncologic and nerve surgeons will ultimately result in improved functional recovery and patient outcomes.
软组织肿瘤治疗的进步，包括成像能力和辅助放射治疗，扩大了手术保肢的适应证和机会。然而，周围神经受累和股神经切除仍可能导致严重的功能后果。神经转移为肿瘤切除后恢复神经功能提供了一种多功能的解决方案。
通过回顾性研究确定了两个病例。收集患者和疾病特征。使用 Medical Research Council Muscle Scale 评估术前和术后的运动功能。使用数字评分量表评估患者的疼痛程度。
采用闭孔神经和坐骨神经的神经转移来恢复膝关节伸展。病例 1 的随访时间为 24 个月，病例 2 为 8 个月。在这两个患者中，膝关节伸展和步态稳定均得到恢复，无需支具固定。患者还表现出 0/10 的疼痛（平均改善 5 分），减少了神经调节剂和止痛药的使用。
神经转移可以恢复功能并提供疼痛控制的益处，理想情况下是在肿瘤切除时进行。肿瘤学家和神经外科医生之间的这种合作最终将导致更好的功能恢复和患者结局。
