Cutaneous saphenous nerve graft for the treatment of sciatic neurotmesis in a dog

Abstract

Case Description—A 2-year-old Griffon Vendéen was examined because of a 1-month history of right hind limb lameness after a traumatic injury. Clinical Findings—Neurologic examination revealed monoplegia and anesthesia of the right hind limb distal to the stifle (femorotibial) joint except for the area supplied by the cutaneous saphenous nerve. Results of electromyographic testing were consistent with a severe lesion of the tibial and peroneal nerves at the level of the stifle joint. Treatment and Outcome—Exploratory surgery revealed an 80-mm-long gap in both the peroneal and tibial branches of the right sciatic nerve. A section of the left cutaneous saphenous nerve was interposed to graft the nerve defects. The dog received joint mechanotherapy and electrophysiologic therapy during the reinnervation process. Ten months after surgery, the dog had recovered almost completely. Neurologic examination revealed diminished flexion of the tarsal and digital joints. Repeat electromyographic testing revealed no abnormal spontaneous electrical activity in the right hind limb musculature, and small compound muscle action potentials were recorded in the right interosseous and cranial tibial muscles. Clinical Relevance—Without surgical treatment, neurotmesis injury results in poor recovery of motor and sensory functions and may result in amputation. If a nerve defect exists, nerve grafting should be considered, even if the procedure is delayed until well after the injury. The sensory portion of the cutaneous saphenous nerve is a potential source of peripheral nerve for grafting in dogs. Reinnervation is a long-term process and physiologic support and owner involvement are necessary, but nearly complete functional recovery is possible.

Traumatic and iatrogenic sciatic nerve injury in 38 dogs and 10 cats: Clinical and electrodiagnostic findings

“…Surgical intervention for traumatic SNI has been widely described, but decision-making remains to be tailored to the individual patient according to clinical, imaging, and EDX results. [47][48][49][50][51] With or without surgical intervention, physiotherapy and the use of tarsus-foot orthosis might be suggested as soon as possible in veterinary patients regardless of predicted outcome. [52][53][54] Indeed, physiotherapy would help maintain muscle tone and avoid fibrosis, whereas the use of orthosis could stabilize the hock joint and prevent cutaneous lesions arising from dragging the hindlimb.…”

Epineural Neurorrhaphy of a Large Nerve Defect Due to IatroGenic Sciatic Nerve Injury in a Maltese Dog

“…Additionally, in the final histopathological examination of the damaged sciatic nerve, a mixture of suture granulomas, caused by the residual suture material in the previous surgery, and axonal degeneration was observed. Without treatment, neurotmesis of a segment of a peripheral nerve results in poor recovery of motor and sensory functions of the affected limb and often leads to limb amputation [ 20 , 21 ]. Debridement of the damaged nerve was performed, and nerve segments were connected using epineural sutures.…”

Pedicled Instep Flap and Tibial Nerve Reconstruction in a Cynomolgus Monkey[Macaca fascicularis]

“…A free nerve graft has to rely on the vascularization of the recipient bed until spontaneous revascularization occurs. In veterinary medicine autologous free nerve grafting has been applied with satisfactory results [ 15 ]. However, the vascularization of nerve grafts becomes principal, where thick grafts are involved, in large defects or in cases such as ours where the graft meets up with a scarred recipient bed; the longer the gap the higher the risk of atrophy as well as fibrous ingrowth into the distal anastomosis area [ 16 ].…”