Lower extremity nerve decompression in burn patients

INTRODUCTION: Generalized neuropathy after burn injury is quite common, but the diagnosis and management of peripheral nerve compression, late after injury, can be difficult. Although the release of upper extremity nerves has been reported, the indications, timing, and outcomes of lower extremity nerve decompression, after burn injury, are not known. METHODS: We performed a descriptive, retrospective, 10-year review of elective peripheral nerve decompression in 107 burn patients, at a regional burn center. Data collected included age, injury type, total body surface area, prior fasciotomy/ escharotomy, preoperative function, electromyography/nerve conduction studies, time from injury to decompression, and decompression site. Main outcome measures included postoperative function, complications, and length of follow-up. RESULTS: Sixteen patients (mean age, 40.2 years; total body surface area, 31%), with thermal (9), electrical (5), and chemical (2) burns, underwent 19 lower extremity nerve decompression procedures, a mean of 23 months after injury, at the following locations: common peroneal (15), superficial peroneal (2), saphenous (1), and sural (1) nerve. Five patients had previous fasciotomy or escharotomy. Preoperatively, 6 patients had foot drop (≤2/5 on motor scale), 6 had weak dorsiflexion (3-4/5), and 2 had no foot drop but abnormal sensation. There were an additional 2 patients who had strictly abnormal sensory findings (1 sural and 1 saphenous nerve compression), which gave a total of 4 patients with impaired sensation. Electromyography/nerve conduction study data were abnormal in 10 of 11 patients tested. Mean tourniquet time was 35 minutes. Of 19 nerves, 14 (73.6%) showed definite improvement, 2 (10.5%) showed mild improvement, and 3 (10.5%) showed no improvement in sensorimotor symptoms. Complications included 2 patients with dehiscence, 2 patients with cellulitis, and 2 patients with failure to improve. Length of follow-up was 20 months. CONCLUSIONS: Lower extremity nerve decompression is effective in improving sensory and motor dysfunction, even late after burn injury, and should be considered in patients with persistent foot drop, paresthesias, and dysesthesias, given the low morbidity of this procedure and high potential for improved function.