Bilateral Sciatic Neuropathy after an Autologous Breast Reconstruction in a Massive Weight Loss Patient
Perioperative compression neuropathy is a known potential complication of prolonged surgical procedures. Sciatic postoperative neuropathy has rarely been reported. We present a 34-year-old woman who underwent right breast reconstruction with supercharged (venous anastomosis) transverse rectus abdominis flap and developed bilateral sciatic compression neuropathy. Her history was remarkable for sleeve gastrectomy 2 years earlier resulting in 105 pound weight loss 1 year before breast reconstruction. During the procedure, the patient was in the supine position for 8 hours and in the semirecumbent position for an additional 2 hours with the torso flexed at 30â€‰degrees and knees flexed at approximately 45â€‰degrees in addition to standard padding. Postoperatively, the patient was found to have loss of sensation and motor paralysis distal to her knees bilaterally. Pain sensation was preserved distally and no other neurological abnormalities were noted. Laboratory tests, magnetic resonance imaging, electromyography, and nerve conduction studies all revealed no evidence of neurological lesions and peroneal or lumbosacral radiculopathy. Motor strength gradually returned to her lower extremities over 4-5 weeks, whereas sensory function continued to improve over 7 weeks. The patient had complete neurological recovery 2 months postoperatively.
Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts
Many burn patients experience more intense pain from the split thickness skin donor site than in the grafted burn wound in their postoperative period. Often, split thickness autografts are harvested from the lateral thigh area, which is innervated by the lateral femoral cutaneous nerve (LFCN). Sonographic nerve localization has been an increasingly popular technique to provide regional nerve blocks and we explore its role in improving pain control during skin harvesting. The LFCN was identified and blocked using ultrasound in 16 patients with a variety of wounds. The donor site was tested and marked after the injection. General anesthesia or sedation was administered after markings were completed. A postoperative survey was performed to assess the return of sensation at the donor site. All blocks were successful with adequate visualization of LFCN using ultrasound. Full anesthesia at the donor site, defined as absence of pain in response to a sharp object prick, was tested at 15 min and confirmed at 20 min after the block. The size of the anesthetized field ranged from 119 to 630 cm(2), with a mean surface area of 268.5 cm(2). Donor site sensation returned within 5-16 h with a mean time of 9.1h. Ultrasound guided LFCN block provides a simple and safe choice of anesthesia for harvesting skin from the lateral thigh.