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Lower Limb Nerve Transfers for Sciatic Nerve Injury. Described and other Viable Options
Alejandra Hay-Gomez, MD1; Alexander Cárdenas Mejía, MD2; Jose E Telich Tarriba, MD3
1Centro Medico Issemym, Metepec, EM, Mexico; 2Plastic and Reconstructive Surgery, Hospital General Dr. "Manuel Gea González", Mexico City, DF, Mexico; 3Hospital Angeles del Pedregal, Mexico City, DF, Mexico

Introduction. Sciatic nerve injury are disabling. Proximal nerves reconstructions such as sciatic nerve are challenging for peripheral nerve surgeon. Motor endplates and target muscles are far away from the sciatic nerve. In case there is a chance to repair it, time for regeneration may be too long. That is why nerve transfers from a neighbor redundant fascicle seems to be the best viable option to preserve end plates union and restore function. For long, there had been only several reports on lower limb nerve transfers. Recently it was brought to many peripheral nerve surgeon’s attention.
Material and methods Three different cases of nerve transfers for sciatic nerve injury are described.
Patient 1. 21 months old female. Presented a sciatic nerve injury after a regional anesthesia block for a inguinal hernia repair 15 months before. Vastus lateralis nerve was transfered to lateral gastrocnemius nerve, and Saphenous nerve was transfered to sural nerve for sensation recovery Patient 2. 57 years old female. Suffered sciatic nerve injury during a endoscopic pyramidal muscle release 2 years prior. Vastus medialis to medial gasctrocnemius, and saphenous to sural nerves were transfered. Additionaly, medium and inferior gluteus nerve branches were transfered to distal stump of sciatic nerve, distal to neuroma Patient 3. 57 years old male. Nine months before suffered sciatic nerve fire weapon injury. Tibial nerve had spontaneous recovery, but peroneus nerve had no signs or reinnervation. During surgical exploration and neurolysis functional redundant semitendinous nerve branches were identified and distal was transfered to deep peroneus nerve.
Results.
The three patients are able to walk after the surgery. Recovery was different in every case, but function was enough for partially restoring the function.
Conclusions Lower limb nerve transfers are a viable option for sciatic nerve injury reconstruction. There are several viable option which are not described yet. We still have many options to explore.


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