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Our experience with surgical treatment of ischial nerve injuries.

OUTLINE
This report presents the results of 44 surgical interventions performed on 44 patients during a period of 15 years, from 1985 to 1999. The report presents the basic lines of surgical treatment performed on a total number of 50 peripheral nerves of lower extremities--nervus ischiadicus and its rami.


PATIENT GROUP AND METHODS
In the whole group of 44 patients, external neurolysis was performed in 23 individuals on 26 nerves. Remaining 21 patients were treated by reconstruction surgery that included 24 injured nerves. In this subgroup, suture of peripheral nerve was performed in 8 treatments on 9 nerves and neural graft was performed in 13 treatments of 15 nerves in cases of complete and persisting neurological deficit, and in the absence of action potentials as revealed by EMG. Complete or severe motoric defects and the absence of spontaneous recovery during the period of several months were the indications for the treatment. The analysis of the efficiency of surgical treatment was performed with respect to the following parameters: period between the injury and operation, patient's age, character of injury, type of injured nerve, and type of surgical intervention.


RESULTS
The best results were obtained in external neurolysis which was applied in traumatic lesions of least severity. The effective degree of recovery M3 was observed in 21 patients (91.3%). With respect to reconstruction surgery, more favourable results were obtained in treatments involving suture (in 6 patients, 75%) than in nerve grafts used for the treatment of the most severe injuries associated with a loss of nerve tissue. In the latter cases, improvement was observed after a delay, and the extent of recovery did not always meet the expectations. The effective degree of recovery was observed in 4 patients (30.8%). Good and excellent results were typical for n. tibialis and they were not dependent on the type of surgical intervention, character and location of the injury, period from the injury or patient's age.


CONCLUSION
Our results demonstrate that late and inappropriate treatment of injured peripheral nerves has severe and disturbing consequences for the patient. If a complete treatment of the injured nerve is not possible by the first contact physician, it should be performed as soon as possible by a specialist trained for microneurosurgical techniques of the treatment of peripheral nerves. (Tab. 6, Ref. 11.)