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17-SEPTEMBER-2003 HUSSEIN NASER QANDEEL 29
YEARS CHEMICAL INJURY TO THE TIBIAL DIVISION LEFT SCIATIC NERVE.
Anamnesis
The patient came to the clinic 05-August-2003
telling that after injection to the left gluteal
area 9 months ago got sciatic pain, analgesia
tibial division of the sciatic nerve and
paralysis of the mentioned division.
On examination: the patient walking limping.
SLRS was 80 degrees with pain left side. Flail
left foot with absent AJ and non function of the
tibial division left leg. EMG and ECS done
24-November-2002 confirming the data.
The left sciatic nerve was
exposed at the upper third of posterior thigh
and followed proximally, elevating the gluteal
muscles. The type of the sciatic nerve is of
high division variant. The tibial division was
splitted from the peroneal. Motor stimulation of
the peroneal was normal with absent in the
tibial division. Inspection of the tibial
division showed a segment of atrophic part of
nerve , which was resected
until the proximal and distal edges showed good
fibrils. The gap was 20 mm. After mobilization
of the nerve, direct anastamoses was achieved
using 4 zero nylon.
Routine closure of the wound.
Smooth postoperative recovery.
FOLLOW UP
The patient
came to the clinic 13-December-2003 with clean wound
and the sensory deficit decreased. The patient was
advised to undergo physiotherapy and treatment.
The patient
then came 18-July-2004 with analgesia shrunken to
the bottom of the left heel and the power of the
gastrocnemius and tibialis posterior improved, but
the distal group of muscles still weak. The patient
was advised to continue the same protocol of
treatment.
The patient
then came several times with ups and downs then came
10-September-2005 with MRI lumbar spine showing
stenosis D9-10. L3-4, 4-5 and L5-S1.
Comments
The very low gluteal area
having the sciatic nerve there, must be avoided
so as not to cause damage to it. Injection
usually is given to the upper lateral quadrant
of the gluteal area. The patient was lucky, that
he has a high variant of sciatic nerve division,
that only the tibial division was affected.
After cut of the nerve, neuroma formation is
usually seen. In chemical injury atrophy of the
nerve will be seen in the affected area.
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