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Femoral Nerve Injury after Rectus Abdominis Muscle Slap Harvesting: A Case Report  

Kim, Jino (Institue for Human Tissue Restoration, Yonsei University College of Medicine, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Lew, Dae Hyun (Institue for Human Tissue Restoration, Yonsei University College of Medicine, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Tark, Kwan Chul (Institue for Human Tissue Restoration, Yonsei University College of Medicine, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.33, no.4, 2006 , pp. 510-513 More about this Journal
Abstract
Purpose: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. Methods: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. Results: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. Conclusion: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.
Keywords
Femoral nerve injury, Rectus abdominis muscle;
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1 Kvist-Poulsen H, Borel J: Iatrogenic femoral neuropathy subsequent to abdominal hysterectomy: incidence and prevention. Obstet Gynecol 60: 516, 1982;
2 Warner MA: Patient positioning and nerve injury. Anesthesiol Clin North America 14: 561, 1996   DOI   ScienceOn
3 Brantigan JW, Owens ML, Moody FC: Femoral neuropathy complicating anticoagulant therapy. Am J Surg 132: 108, 1976   DOI   ScienceOn
4 McDaniel GC, Kirkley WH, Gilbert JC: Femoral nerve injury associated with the Pfannenstiel incision and abdominal retractors. Am J Obstet Gynecol 87: 381, 1963   DOI
5 Burnett AL, Brendler CB: Femoral neuropathy following major pelvic surgery: etiology and prevention. J Ural 151: 163, 1994   DOI
6 Han HJ, Chae SU, An DS: Delayed sciatic nerve injury after a total hip arthroplasty in developmental dislocation of the hip. A Case Report. The J Korean Hip Soc 15: 71, 2003
7 Boontje AH, Haaxma R: Femoral neuropathy as a complication of aortic surgery. J Cardiovasc Surg 28: 286, 1987
8 Hsieh LF, Liaw ES, Olen HY, Hong CZ: Bilateral femoral neuropathy after vaginal hysterectomy. Arch Phys Med Rehabil 79: 1018, 1998   DOI   ScienceOn