Early Surgical Intervention Is the Key
At the Department of Plastic, Reconstructive & Aesthetic Surgery, Innsbruck Medical University, a total of 23 patients (16 female, 7 male, mean age: 52.7 years) were treated for iatrogenic femoral nerve injuries between 2000 and 2010. In our patient population the main causes of nerve injury were the same as those reported by Antoniadis et al. (1). Preoperatively, the primary focus was on taking the patient’s history and performing a physical examination, including the collection of information about sensory and motor losses. Here, the clinical-interdisciplinary, neurological and neuro-ultrasonographic examination proved to be valuable. Ultrasonography, performed by an experienced radiologist, can determine the exact location of the damage. Nerve regeneration, which may occur with time, can be monitored by means of electromyography and nerve conduction velocity tests, combined with a wandering Tinel’s sign.
Piza-Katzer et al. (2) demonstrated the advantages of early surgical revision in cases with persistent loss of nerve function without clinical signs of improvement. Thus, we decided to perform surgical revisions in affected patients already after 3 months if no improvement of the clinical signs and symptoms and no wandering of Tinel’s sign was observed. With this approach, the time between nerve injury and surgical revision was reduced from approx. 12 months to 6.4 months between 2008 and 2010. The time between the nerve injury and the referral to our hospital accounted for approx. 3 months of this period.
In summary, we can only agree with the authors of the article. Early surgical intervention can help to shorten these patients’ suffering, and clinical regeneration can be achieved much earlier. In addition, the progressive muscle atrophy is stopped, resulting in faster rehabilitation. Once again we would like to point out that the mere suspicion of a nerve injury should trigger the patient’s immediate referral to an expert to ensure that the rapid intervention approach is actually practiced.
Dr. med. univ. Gabriel Djedovic
PD Dr. med. Ulrich M. Rieger
Klinik für Plastische und Ästhetische,
Wiederherstellungs- und Handchirurgie
Frankfurt am Main
Dr. med. Eva-Maria Baur
Universitätsklinik für Plastische,
Rekonstruktive und Ästhetische Chirurgie,
Medizinische Universität Innsbruck
|1.||Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CPG, Richter HP: Iatrogenic neurological damage—prevalence, diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 273–9. VOLLTEXT|
|2.||Piza-Katzer H, Schöller T, Stichelberger M: Iatrogen femoral nerve lesions. Handchir Mikrochir plast Chir 2009; 41: 230–7 CrossRef MEDLINE|