Median nerve repair with autologous sciatic nerve graft: a case report

Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis. Case Description. A 25-year-old soldier presented to a military hospital in Afghanistan following a roadside bomb attack. The patient had a medial shrapnel wound in the bicipital groove with a cool pulseless hand and catastrophic lower extremity injuries. Bilateral above-the-knee amputations (AKAs) and exploration of the medial shrapnel wound were undertaken. A 7 cm traumatic defect in the median nerve was repaired with interpositional sciatic nerve graft harvested from the AKA. Conclusion. Recovery of motor function after nerve grafting is dependent on motor axons reinnervating target muscles, making proximal nerve injuries problematic. We identify a potential nerve harvest site in patients with lower extremity amputations in need of long segment nerve repairs.