Immediate grafting of transected obturator nerve during radical hysterectomy.
BACKGROUND
Intraoperative injury of obturator nerve has rarely been reported in patients with gynecological malignancies who undergo extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end to end anastomosis or grafting when achieving tension-free anastomosis is not possible.


METHODS
A 46-year-old woman with stage IIA cervical cancer underwent radical hysterectomy and bilateral pelvic lymphadenectomy. Left obturator nerve was damaged intraoperatively during pelvic dissection. Immediate microsurgical grafting of the sural nerve was successful and there was no functional deficit in the left thigh for 6 months postoperatively.


CONCLUSIONS
As far as transection and damage of obturator nerve cause thigh claudication, paresthesia and cosmetic problems due to atrophy of related group of muscles, we recommend precise anastomosis of this nerve and grafting whenever achieving a tension-free anastomosis is not possible.
Gynecology Oncology Department, Tehran University of Medical Sciences, Tehran, Iran. valrec2@yahoo.com
Fatemeh
F
Ghaemmaghami
Fariba
F
Behnamfar
Hooshang
H
Saberi
D000714:Anastomosis, Surgical; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D009776:Obturator Nerve / Q000293:injuries* / Q000601:surgery; D013497:Sural Nerve / Q000637:transplantation; D020196:Trauma, Nervous System / Q000209:etiology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000601:surgery*