Acute sciatic nerve palsy secondary to postoperative seroma following soft tissue sarcoma resection: A case report

Seroma is a common complication following soft tissue sarcoma resection of lower extremity and might cause functional limitation, infection, prolonged postoperative course and delay in adjuvant treatment. This study aims to report on acute sciatic nerve palsy secondary to postoperative collection following soft tissue sarcoma resection.

A 70-year-old male underwent radical re-resection of recurrent liposarcoma of right thigh with end-to-end anastomosis of femoral vein and artery. It was complicated by deep vein thrombosis and pulmonary embolism requiring therapeutic anticoagulation. On day 12 postoperatively, the patient developed seroma/hematoma compressing the sciatic nerve and resulting in complete paralysis and loss of sensation. An emergent incision and drainage with evacuation of the collection was performed. The patient regained near complete neurological function and was maintained on therapeutic anticoagulation.

Seroma formation following STS resection results in a complex postoperative course with a prolonged hospital stay, functional limitations, wound complications and delayed adjuvant treatment. Acute sciatic nerve palsy secondary to compartment syndrome is a serious complication that can lead to worse outcomes requiring close follow-up and intervention. There is no consensus on the appropriate treatment and several options exist ranging from non-operative drain application and needle aspiration to surgical evacuation and debridement.

Acute sciatic nerve palsy is a rare complication secondary to compression by seroma/hematoma following soft tissue sarcoma resection. The latter complication is reversible with adequate monitoring and prompt timely intervention especially in patients using potent anticoagulants.