Restoration of hamstring function following sciatic nerve resection at the greater sciatic foramen with reconstruction involving acellular nerve allograft and vascularized sural nerve autograft: A case report.

Journal Article

Segmental loss of the sciatic nerve secondary to oncologic resection or trauma is detrimental to hamstring and leg function. The diameter of this nerve and the length of its axons spanning the lower extremity create significant challenges in reconstruction and optimizing return of sensory or motor function. The purpose of this report is to describe outcomes of a free vascularized sural nerve graft to preserve hamstring function in a large proximal sciatic nerve defect beginning at the greater sciatic foramen. A 44-year-old female underwent neoadjuvant chemotherapy and radiation for treatment of a left sciatic nerve synovial cell sarcoma. The patient underwent R0 resection of the proximal left sciatic nerve resulting in a 15 cm defect. An ipsilateral vascularized sural nerve graft was used to reconstruct the medial aspect of the sciatic nerve, prioritizing the tibial division, in an effort to restore hamstring function and plantar sensation. A 5 cm allograft nerve was added to the cutaneous branches of the sural nerve graft to better span the large defect and reconstruct the lateral aspect of the nerve. The patient's postoperative course was uneventful. At 1-year follow-up, the patient showed MRC grade 4/5 strength with knee flexion and steady gait pattern with a left ankle-foot orthosis. Outcomes support the use of a single vascularized nerve graft alongside acellular nerve allograft to restore motor function in large diameter and large defect mixed nerve injuries.

Full Text

Duke Authors

Cited Authors

  • Sarcon, AK; Li, NY; Houdek, MT; Moran, SL

Published Date

  • November 2022

Published In

Volume / Issue

  • 42 / 8

Start / End Page

  • 824 - 828

PubMed ID

  • 36177748

Electronic International Standard Serial Number (EISSN)

  • 1098-2752

Digital Object Identifier (DOI)

  • 10.1002/micr.30970


  • eng

Conference Location

  • United States