Department of Orthopedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan.
Department of Plastic Surgery, Kyushu University, Fukuoka, Japan.
Microsurgery. 2024 Jan;44(1):e31034. doi: 10.1002/micr.31034. Epub 2023 Mar 13.
Concomitant resection of the sciatic nerve along with a malignant tumor is no longer a contraindication for limb-sparing surgery, as most of these patients remain ambulatory. However, sciatic nerve reconstruction after sarcoma resection is not commonly performed. Restoration of nerve function can improve patient quality of life. We describe our experience with four patients who underwent sciatic nerve reconstruction using an ipsilateral common peroneal nerve graft at the time of sarcoma resection.
Because of the low chance of peroneal nerve recovery, the ipsilateral peroneal trunk was used as a graft to reconstruct the tibial trunk of the sciatic nerve. Two patients were men and two were women. Mean age was 45.3 years (range, 15-62). Mean sciatic nerve defect length was 9.4 cm (range, 8.5-12.0). Proximal thigh defects (three patients) were reconstructed with a double cable; the one patient with a distal thigh defect underwent single cable reconstruction. Mean operation time was 492 min (range, 428-682).
Mean length of the harvested peroneal trunks was 21 cm (range, 11-26). Mean graft length was 11.9 cm (range, 11-13). Postoperative course was uneventful in all four patients. One patient died of sarcoma lung metastasis and could not be evaluated. Three patients were followed for more than 2 years. Two patients achieved British Medical Research Council grade 4 plantar flexion; the remaining patient achieved grade 5 plantar flexion and grade 4 toe flexion. Semmes-Weinstein monofilament sensory testing showed loss of protective sensation on the plantar surface in all three. Musculoskeletal Tumor Society scores at last follow-up were 60.0%, 70.0%, and 43.3%, respectively.
Immediate sciatic nerve reconstruction using an ipsilateral common peroneal nerve graft avoids reconstruction delay and scar tissue formation, which is advantageous for nerve recovery. This technique may be considered when sciatic nerve resection is anticipated during sarcoma resection.
随着保肢手术的发展，坐骨神经与恶性肿瘤一并切除已不再是手术的禁忌证，因为大多数患者仍可保持活动能力。然而，肉瘤切除后坐骨神经的重建并不常见。神经功能的恢复可以提高患者的生活质量。我们描述了 4 例在肉瘤切除时使用同侧腓总神经移植物进行坐骨神经重建的经验。
由于腓总神经恢复的可能性较低，我们使用同侧腓总干作为移植物来重建坐骨神经的胫干。2 例男性，2 例女性。平均年龄 45.3 岁（范围，15-62 岁）。坐骨神经缺损平均长度为 9.4cm（范围，8.5-12.0cm）。3 例大腿近端缺损采用双股电缆重建，1 例大腿远端缺损采用单股电缆重建。平均手术时间为 492 分钟（范围，428-682 分钟）。
腓总干平均采集长度为 21cm（范围，11-26cm）。移植物平均长度为 11.9cm（范围，11-13cm）。所有 4 例患者术后均未出现并发症。1 例患者因肉瘤肺转移死亡，无法评估。3 例患者随访超过 2 年。2 例患者获得英国医学研究理事会（British Medical Research Council）4 级跖屈；其余患者获得 5 级跖屈和 4 级趾屈。3 例患者的 Semmes-Weinstein 单丝触觉测试显示足底保护性感觉丧失。末次随访时，肌肉骨骼肿瘤学会（Musculoskeletal Tumor Society）评分分别为 60.0%、70.0%和 43.3%。
使用同侧腓总神经移植物立即进行坐骨神经重建可避免重建延迟和瘢痕组织形成，有利于神经恢复。在预计肉瘤切除时需要切除坐骨神经时，可以考虑这种技术。
