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Editorial Plastic and Aesthetic Research

Peripheral nerve injuries

Katerina Anesti , Paul Caine 2
1
1 Department of Plastic Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK.
2 Department of Plastic Surgery, St Andrew’s Centre, Mid Essex NHS Trust, Chelmsford, CM1 7ET, UK.
Address for correspondence: Miss. Katerina Anesti, Department of Plastic Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter,
EX2 5DW, UK. E-mail: katanest@doctors.org.uk

[7]
Nerve injuries caused by medical interventions and sciatic nerve injuries, respectively. [5,6] Topuz et al.
(iatrogenic lesions) can complicate procedures and affect attributed sciatic nerve damage to intragluteal injections
any part of the peripheral nervous system. Available data in approximately 40% of their patients. The high risk
are fragmentary and little information is accessible on the procedures that often result in peripheral nerve damage
overall incidence of iatrogenic nerve lesions that ranges include: osteosynthesis, arthrodesis, posterior triangle
from 1.5% to 15%. [1,2] Major drawbacks are the limited lymph node biopsies, carpal tunnel release, surgery
number of patients studied and the incomplete and for varicose veins, baker cyst excision and inguinal
subjective assessment of nerve function. The potential for herniorrhaphy. [8]
iatrogenic injuries in the course of any surgical procedure The use of pneumatic surgical tourniquets is a key in
should be thoroughly appreciated by all surgeons and providing a bloodless environment in distal extremities.
they should be familiar with early diagnostic steps for They also have a crucial role in the application of regional
detecting these lesions. The importance of prompt diagnosis anesthesia. However, they can result in complications
and adequate treatment of iatrogenic nerve injuries for including: skin damage, nerve and vascular injury and also
optimal functional recovery should be stressed. Excellent postoperative swelling. Nerve injury related to tourniquets
results can be obtained if certain diagnostic and surgical results from two pathological processes: mechanical
principles are followed. compression and neural ischemia. Horlocker et al. found
[9]
Iatrogenic injuries during surgery are becoming more there to be a three‑fold increase in risk of nerve damage
widely documented as we begin to see surges in insurance for every 30 min increase in tourniquet inflation time.
claims. A review of insurance claims filed by patients Tourniquet related nerve injury is widely documented
[10]
who had undergone otorhinolaryngological procedures in in the literature, however, permanent femoral nerve
Finland found a total of 422 claims over a 4‑year‑period. injury secondary to tourniquet use is sparsely reported.
Iatrogenic nerve injury accounted for 30 patients; 10 patients Mingo‑Robinet reported a permanent femoral nerve palsy
suffered facial nerve damage (secondary to ear and parotid secondary to tourniquet use in patella fracture surgery. [11]
gland surgery) and 10 suffered trigeminal nerve injury It has been documented in the literature that iatrogenic
(secondary to maxilary sinus surgery). A series by nerve injury can arise from enucleation of peripheral
[1]
[2]
Kretschmer et al. looking at 722 patients with peripheral schwannomas by both an extra and intracapsular
nerve trauma found that approximately 17.4% were iatrogenic approach. The reported incidence of iatrogenic injury has
injuries with the majority (94%) being secondary to a surgical been found to range from 13% of cases for motor deficit
[12]
procedure. Seventeen percent of injuries occurred to the up to 50% for sensory deficit. Park et al. reported
[13]
[14]
median nerve, 16% to the accessory, 13% to the radial and values as high as 73% of new neurological deficit after
common peroneal, 8.5% to the ulnar and 5% to the femoral enucleation. A review of nerves injured and the length
nerves, respectively. Spinal accessory nerve injuries of neurological deficit was carried out by Date et al.
[3]
[15]
resulting from medical intervention have been quoted as Upper limb nerves were affected and included: the radial
high as 94% and figures of 60% and 25.2% for femoral
[4]
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How to cite this article: Anesti K, Caine P. Peripheral nerve injuries.
DOI: Plast Aesthet Res 2015;2:309-10.
10.4103/2347-9264.169500
Received: 03-05-2015; Accepted: 06-09-2015
© 2015 Plastic and Aesthetic Research | Published by Wolters Kluwer ‑ Medknow 309