title: Sciatic neuropathy after body contouring surgery in massive weight loss patients.
abstract: To date, obesity affects a substantial population in industrialised countries. Due to the increased awareness of obesity-related morbidity, efficient dietary regimens and the recent successes with bariatric surgery, there is now a high demand for body contouring surgery to correct skin abundancies after massive weight loss. The known risks for this type of surgery are mainly wound-healing complications, and, more rarely, thromboembolic or respiratory complications. We present two female patients (23 and 39 years of age) who, in spite of standard positioning and precautions, developed sciatic neuropathy after combined body contouring procedures, including abdominoplasty and inner thigh lift. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the left side in patient one and bilaterally in patient two. Full nerve conductance recovery was obtained after 6 months in both patients. Although the occurrence of spontaneous neuropathies after heavy weight loss is well documented, this is the first report describing the appearance of such a phenomenon following body contouring surgery. One theoretical explanation may be the compression of the nerve during the semirecumbent positioning combined with hip flexion and abduction, which was required for abdominal closure and simultaneous access to the inner thighs. We advise to avoid this positioning and to include the risk of sciatic neuropathy in the routine preoperative information of patients scheduled for body contouring surgery after heavy weight loss.
authors.affiliation: Department of Plastic and Hand Surgery, Inselspital, University of Bern, Bern, Switzerland. david.kiermeir@insel.ch
authors.forename: David
authors.initials: D
authors.lastname: Kiermeir
authors.forename: Andrej
authors.initials: A
authors.lastname: Banic
authors.forename: Kai
authors.initials: K
authors.lastname: Rösler
authors.forename: Dominique
authors.initials: D
authors.lastname: Erni
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D062109:Dermatologic Surgical Procedures; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D020426:Sciatic Neuropathy / Q000175:diagnosis / Q000209:etiology*; D013848:Thigh / Q000601:surgery; D015431:Weight Loss; D014945:Wound Healing; D055815:Young Adult