Bilateral Sciatic Neuropathy after an Autologous Breast Reconstruction in a Massive Weight Loss Patient

Abstract

Summary: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 30 degrees and knees flexed at approximately 45 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.

A Systematic Review of Breast Reconstruction Options After Mastectomy in Massive Weight Loss Patients

“…Although favor has largely changed to prefer muscle sparing abdominal based perforator flaps, a unique case report was found describing bilateral sciatic neuropathy after a unilateral pedicled, supercharged TRAM flap in a patient with a history of MWL 16 . The 34-year-old patient was in the supine position for 8 hours on standard padding and was then transitioned to a semirecumbent position for 2 additional hours 16 .…”

“…Although favor has largely changed to prefer muscle sparing abdominal based perforator flaps, a unique case report was found describing bilateral sciatic neuropathy after a unilateral pedicled, supercharged TRAM flap in a patient with a history of MWL 16 . The 34-year-old patient was in the supine position for 8 hours on standard padding and was then transitioned to a semirecumbent position for 2 additional hours 16 . Postoperatively, the patient experienced bilateral motor and sensory loss from knees distally, with no abnormalities revealed on electrolyte panel, magnetic resonance imaging of the spine, electromyography, or nerve conduction study 16 .…”

“…Based on the reviewed articles, abdominally based flap reconstruction is a safe option for MWL women requiring breast reconstruction and provides an aesthetically acceptable result that can be associated with high levels of patient satisfaction. [16][17][18][20][21][22][23][24][25] In addition to a successful breast reconstruction, abdominally based flaps can also contribute to a favorable abdominal contour with removal of excess tissue resulting from MWL. 20 Based on results, it is safe to delay an autologous breast reconstruction with abdominally based flaps to undergo bariatric surgery and return for breast reconstruction after MWL is achieved.…”

Cadaveric Study for Safe Elevation of a Profunda Artery Perforator Flap: Anatomy of the Perforators and Obturator Nerves

“…Few studies have reported on sciatic nerve palsy occurring after breast surgery or body contouring surgery (24,25). This phenomenon may be the "piriformis syndrome", which is a form of sciatica caused by compression of the sciatic nerve by the piriformis muscle (26).…”

“…Few studies have reported on sciatic nerve palsy occurring after breast surgery or body contouring surgery. 24 25 This phenomenon may be the “piriformis syndrome,” which is a form of sciatica caused by compression of the sciatic nerve by the piriformis muscle. 26 Of the sciatic nerves, 90% has traditional anatomy with an undivided sciatic nerve emerging below the piriformis muscle in a cadaveric study.…”