Therapeutic Results of Sciatic Nerve Repair in Iran-Iraq War Casualties

Abstract

The sciatic nerve is composed of two independent divisions: tibial and peroneal. The results of the repair of these two nerves are not identical. This retrospective study was carried out with the aim of evaluating the results of different therapeutic procedures for sciatic nerve injuries and conducting a comparative evaluation of peroneal and tibial nerve recovery. A total of 648 Iranian casualties of the 1980 to 1988 Iran-Iraq war with sciatic nerve injury were treated with nerve grafting, direct end-to-end coaptation, and neurolysis. Patients were subdivided according to nerve injury site into three groups of upper, middle, and lower thirds of the thigh, and followed from 5 to 12 years. In 77.8 percent of patients, the tibial nerve was injured, and in 88.9 percent, the common peroneal nerve was injured. Protective sensation recovery of the sole was evaluated as good in 69.1 percent of those with upper third injuries, 74.4 percent of those with middle third injuries, and 89.3 percent of those with lower third repairs (p < 0.0001), with an overall success rate of 73.4 percent. The overall motor recovery success rate for the three techniques was 86.3 percent for the tibial nerve and 38.9 percent for the common peroneal nerve. Results of sciatic nerve injury treatment in this group of war casualties were generally satisfactory. Tibial nerve injury repair in the upper thigh has a higher priority than the peroneal nerve. Motor deficits of the common peroneal nerve can be overcome by tendon transfer or orthopedic devices.