Combat Injury of the Sciatic Nerve – An Institutional Experience

INTRODUCTION: Combat injury of the sciatic nerve tends to be severe with variable but often profound consequences, is often associated with widespread soft tissue and bone injuries, significant neurologic impairment, severe neuropathic pain, and a prolonged recovery time. There is little contemporary data that describes the treatment and outcome of this significant military acquired peripheral nerve injury. We describe our institution's experience treating patients with combat-acquired sciatic nerve injury in the recent Iraq and Afghanistan wars. MATERIALS AND METHODS: IRB approval was obtained, and a retrospective review was performed of the records of 5,137 combat-related extremity injuries between June 2007 and June 2015 to identify patients with combat-acquired sciatic nerve injury without traumatic amputation of the injured leg. The most common mechanisms of injury were gunshot wound to the upper thigh or pelvis, followed by blast injury. Thirteen patients were identified that underwent sciatic nerve exploration and repair. Nine patients had nerve repair using long-length acellular cadaveric allografts. Five patients underwent nerve surgery within 30 d of injury and eight had surgery on a delayed basis. The postoperative follow-up period was at least 2 yr. RESULTS: Reduction of neuropathic pain was significant, 7/10 points on the 11-point pain intensity numerical rating scale. Eight patients displayed electrodiagnostic evidence of reinnervation distal to the injury zone; however, functional recovery was poor, as only 3 of 10 patients had detectable motor units distal to the knee, and recovery was only in tibial nerve innervated muscles. There were no serious surgical complications, in particular, wound infection or graft rejection associated with long-length cadaver allograft placement. CONCLUSION: Early surgery to repair sciatic nerve injury possibly promotes significant pain reduction, reduces narcotic usage and facilitates a long rehabilitation process. Allograft nerve placement is not associated with serious complications. A follow-up period longer than 3 yr would be required and is ongoing to assess the efficacy of our treatment of patients with combat-acquired sciatic nerve injury.