Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs

Abstract

A successful outcome is most probable following the low-level repairs, within the first 4 months after injury, and using grafts shorter than 5 cm. Other repairs can also be beneficial in preventing dangerous anesthesia of the sole of the foot and enabling almost normal walking.

First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

“…36 Although we do not report a control of sural graft alone in this patient series, historical data from Roganovic et al demonstrate that worse outcomes started with nerve defects > 5 cm in patients with injuries to the tibial nerve or tibial division of the sciatic nerve who were treated with sural nerve grafts or nerve grafts from other sources alone. 35 Although a larger sample size is necessary, here we demonstrate good outcomes in 2 patients with nerve gaps ≥ 5 cm by using sural nerve grafts supplemented with autologous SCs.…”

“…Both patients had significant improvement in both motor and sensory function, with correlative imaging, after large-gap (> 5 cm) injuries generally associated with poor functional recovery. 35 Near complete resolution and significant improvement in pain symptoms in the patients in Cases 1 and 2, respectively, were observed-an outcome rarely seen in autologous nerve grafting. A proposed mechanism for pain reduction in entubulation strategies is that AGCs provide a scaffold for more directional growth of axons and less growth of pain fibers.…”

“…Donor SCs were able to propagate to sufficient amounts for transplantation in both patients far earlier than 4 months, when poor outcomes are seen. 35 Grafts remained in continuity and no neuromas or tumors were seen at 12 and 36 months.…”

“…High sciatic injuries involving the peroneal component have been associated with poor outcomes, whereas midthigh injuries to the tibi-al component have had higher rates of success. 2,32,35 Along with location and sciatic division, nerve gaps > 5 cm have been associated with worse outcomes. 35 Repair of a damaged sciatic nerve that has a significant gap is particularly challenging due to several factors.…”

“…2,32,35 Along with location and sciatic division, nerve gaps > 5 cm have been associated with worse outcomes. 35 Repair of a damaged sciatic nerve that has a significant gap is particularly challenging due to several factors. Sural nerves, the most common donor autograft, are typically insufficient in length due to the large discrepancy in crosssectional area between donor and sciatic nerve.…”