The most commonly injured nerves at surgery: A comprehensive review

Abstract

Iatrogenic nerve injury during surgery is a major source of concern for both patients and surgeons. This study aimed to identify the nerves most commonly injured during surgery, along with the commonly associated operative procedures. A literature search was conducted using the PubMed database to identify nerves commonly injured during surgery, along with the surgical procedure associated with the injury. The following 11 nerves, ranked in order with their associated surgical procedures, were found to be the most commonly injured: (a) intercostobrachial nerve in axillary lymph node dissections and transaxillary breast augmentations, (b) vestibulocochlear nerve in cerebellopontine tumor resections and vestibular schwannoma removals, c) facial nerve in surgeries of the inner ear and cheek region, (d) long thoracic nerve in axillary lymph node dissections, (e) spinal accessory nerve in surgeries of the posterior triangle of the neck and cervical lymph node biopsies, (f) recurrent laryngeal nerve in thyroid surgeries, (g) genitofemoral nerve in inguinal hernia and varicocele surgeries, (h) sciatic nerve in acetabular fracture repairs and osteotomies, (i) median nerve in carpal tunnel release surgeries, (j) common fibular nerve in varicose vein and short saphenous vein surgeries, and (k) ulnar nerve in supracondylar fracture surgeries. Although the root cause of iatrogenic nerve injury differs for each nerve, there are four unifying factors that could potentially decrease this risk for all peripheral nerves. These four influencing factors include knowledge of potential anatomical variations, visual identification of at‐risk nerves during the procedure, intraoperative nerve monitoring, and expertise of the surgeon.

‘EngNT’ — Engineering live neural tissue for nerve replacement

“…While the obvious application is in bridging long gap injuries, by removing the limitations associated with autograft availability and morbidity it also opens up a wider range of opportunities. For example, having readily available living nerve tissue could improve outcomes in shorter gaps where autografting would currently be beneficial but not justifiable, or outside specialist referral centres where the expertise, infrastructure or time required for autograft is not available, or where unplanned iatrogenic nerve injury would benefit from immediate repair [ 45 ]. Other scenarios beyond peripheral nerve might include the treatment of optic nerve and spinal cord injury.…”

Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury

“…Well known examples are the patellar branches of the saphenous nerve during knee surgery, the abdominal intercostal nerves during laparotomies, the superficial peroneal nerve during anterior tibial compartment syndrome release, the sural nerve during lateral ankle surgery, and the accessory nerve during lymph node biopsy. The course of these nerves makes them vulnerable to direct damage during incision, traction injury from skin and subcutis retractors, and stretch by the manipulation or compression of the joint to gain surgical access, or during the surgery itself with the use of clamps or osteosynthesis material [8,9]. Iatrogenic nerve injury is now considered a calculated risk in many procedures, that the patient should be informed about before the surgery.…”

“…When the trauma was a medical procedure, the disorder was called iatrogenic PNS injury. Although this may pose an uncomfortable topic for the treating physician and hospital insurers, it is well known that certain procedures carry a small but inherent risk of inadvertent injury to adjacent nerves, even when performed correctly [ 8 , 9 ]. A frequent example is a traction injury of the peroneal (fibular) nerve portion of the sciatic nerve during hip joint replacement surgery, this occurs in 2–5% of patients during the first procedure and in 10% or more during revision surgery [ 10 ].…”

The spinal accessory nerve and its entry point into the posterior triangle of the neck

“…Most spinal accessory nerve injuries are iatrogenic in nature [6]. The literature demonstrates that it is one of the most commonly injured nerves during surgery across all specialties [20]. The anatomy of the nerve puts it at risk during otolaryngological surgery involving the lateral skull base, superior neck and posterior triangle [7][15].…”