Common Peroneal Nerve Palsy Caused by Compression Stockings After Surgery

Biomedical therapeutic compression textiles: Physical-mechanical property analysis to precise pressure management

Biomedical therapeutic compression textiles (TCTs) have been extensively applied in the prevention and treatment of chronic venous insufficiency of lower extremities. An efficiency and operable development strategy to achieve the morphologic control and pressure fitness of TCTs needs to be proposed to improve the medical precision and patient adherence. Therefore, the present study qualitatively explored the influencing mechanisms of each knitting variable on physical-mechanical properties and pressure behaviors of TCTs. Then constructed the quantitative models to digitalize the knitting variables for determination of yarn-machinery setting design values. The results revealed that the feeding velocity of elastic inlay yarn materials and loop size settings impacted the pressure values owing to the diversities of fabric dimensions and mechanical tensile properties, respectively. Simultaneously, the derivation ratios of proposed circumferential and pressure models evaluated by experimental validated trials were approximately 1.1% and 10.8%, respectively. This study provided the fundamental references for the design, manufacturing, and property controlling of compression textiles to improve the biomedical therapeutic effectiveness for targeted users.

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

BACKGROUND

Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later.

PURPOSE

This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors.

METHODS

A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses.

RESULTS

Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

A Systematic Review of Peripheral Neuropathies in Breast Cancer-Related Lymphedema

Controversy exists regarding the influence of breast cancer-related lymphedema (BCRL) in the development of peripheral neuropathies. Our aim was to evaluate the association of secondary lymphedema with peripheral neuropathies in patients with breast cancer. We performed a systematic review by querying PubMed, EMBASE, Ovid Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials databases. The keywords "lymphedema" AND ("neuropathy" OR "carpal tunnel syndrome" OR "cubital tunnel syndrome" OR "neuropathic pain") and synonyms in titles and abstracts were used to perform the search. Seventeen articles met the inclusion criteria. Discrepancies were found in studies that analyzed whether a cause-effect association exists between carpal tunnel syndrome (CTS) and secondary lymphedema. No evidence indicated that lymphedema predisposes to developing peripheral neuropathies such as CTS or brachial plexopathy. No studies found an association between patients with breast cancer at risk of or with lymphedema and the development or worsening of CTS. Carpal tunnel release can be safely performed in patients with BCRL. Neuropathic pain worsens with lymphedema, and treatment seems to improve the pain. Our study did not find enough evidence to conclude that BCRL is associated with the development of peripheral neuropathies. Carpal tunnel release is a safe procedure that can be performed in patients with BCRL and does not influence the development or worsening of lymphedema. Neuropathic pain seems to worsen after development of lymphedema, and treatment has been found to improve neuropathic pain.

Risks and contraindications of medical compression treatment - A critical reappraisal. An international consensus statement

OBJECTIVES

Medical compression therapy is used for non-invasive treatment of venous and lymphatic diseases. Medical compression therapy-associated adverse events and contraindications have been reported, although some contraindications are theoretically based. This consensus statement provides recommendations on medical compression therapy risks and contraindications.

METHODS

A systematic literature search of medical compression therapy publications reporting adverse events up until November 2017 was performed. A consensus panel comprising 15 international experts critically reviewed the publications and formulated the recommendations.

RESULTS

Sixty-two publications reporting medical compression therapy adverse events were identified. The consensus panel issued 21 recommendations on medical compression therapy contraindications and adverse event risk mitigation, in addition to reviewing medical compression therapy use in borderline indications. The most frequently reported non-severe medical compression therapy-associated adverse events included skin irritation, discomfort and pain. Very rare but severe adverse events, including soft tissue and nerve injury, were also identified.

CONCLUSION

This consensus statement summarises published medical compression therapy-associated adverse events and contraindications, and provides guidance on medical compression therapy. Severe medical compression therapy-associated adverse events are very rarely encountered if compression is used correctly and contraindications are considered.

The role of clothing on participation of persons with a physical disability: A scoping review

Determining ways to facilitate participation of persons with a physical disability is crucial and clothing may play a central role. This review aims to synthesize and examine the role of clothing on participation of persons with a physical disability. Six research databases and grey literature were searched following Arksey & O'Malley's six steps, including multiple expert consultations. English and French articles contributing to how clothing affects participation were included and tabulated based on the International Classification of Functioning, Disability and Health. Fifty-seven articles and 88 websites were included. A variety of stakeholder perspectives, diagnoses, and types of clothing were represented. Clothing mostly influences mobility and self-care, as well as various personal factors. Forty-nine percent of articles reported essential clothing design features to consider. Clothing is an important and complex environmental factor that interacts with all health domains, including participation. Future research should consider intersectoral initiatives.

[Surgical decompression of the peroneal nerve at the level of the fibular head]

OBJECTIVE

Functional and sensible regeneration of deficits related to common peroneal nerve palsy.

INDICATIONS

Functional deficits like foot drop, malfunctioning pronation, foot in supination and sensible deficits located at the anterior and lateral lower leg, the dorsum of the foot, the extension side of toes 1-4 and the interdigital space between toe 1 and 2, for positive Hoffmann-Tinel sign located at the fibular head and steppage gait.

CONTRAINDICATIONS

Infection, spinal cord damage and spinal cord tumors with related sensitivity disorders and paralysis, advanced multiple sclerosis, amyotrophic lateral sclerosis, pAVK IV, reinnervation refractory muscles with denervation >15-18 months, polyneuropathy, previous nerve lesions by direct trauma.

SURGICAL TECHNIQUE

Surgery in lateral position and thigh tourniquet. L‑Shaped incision made in accordance with the marking. Nerve release by fasciotomy first proximal, then distal up to the branching. Opening of the thigh tourniquet, careful coagulation. Insertion of a Mini Redovac Drainage, subcutaneous and skin sutures. Compression bandage.

POSTOPERATIVE MANAGEMENT

Full mobilization on postoperative day 1. An electric stimulation therapy can be considered after drainage removal. After suture removal physio- and ergotherapy indicated. Check ups should be performed every 3 months with clinical exams, photo and video documentation. Four months after surgery an electroneurographic exam should be done. Follow-up should be performed for 24 months.

RESULTS

From 2010-2018 15 patients received decompression of the common peroneal nerve. Sensibility, functionality and subjective feeling were evaluated. In 12 patients (80%) a full recovery, in one case (6.67%) a partial recovery and in 2 cases (13.33%) no recovery was observed.

Radial Nerve Injury Caused by Compression Garment for Lymphedema: A Case Report

Lymphedema is a condition characterized by localized fluid retention and tissue swelling caused by a compromised lymphatic system. To minimize fluid buildup and stimulate the flow of fluid through the lymphatic system, compression garments are usually applied to patients with lymphedema. There are few studies to report complications of compression garments to treat breast cancer-related lymphedema. To our knowledge, this is the first report of radial nerve compression neuropathy associated with wearing a compression garment to treat lymphedema. Level of Evidence: V.

American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Perioperative Management

A wide range of factors contribute to the complexity of the management plan for an individual patient, and it is the surgeon's responsibility to consider the clinical variables and to guide the patient through the perioperative period. In an effort to address a number of important variables, the American College of Foot and Ankle Surgeons convened a panel of experts to derive a clinical consensus statement to address selected issues associated with the perioperative management of foot and ankle surgical patients.

Progressive foot drop caused by below-knee compression stocking after spinal surgery

Foot drop is a debilitating condition, which may take many months to recover. The most common cause of foot drop is a neuropathy of the common peroneal nerve (CPN). However, similar symptoms can be caused by proximal lesions of the sciatic nerve, lumbar plexus or L5 nerve root. We present a rare and unusual case of a patient undergoing spinal surgery at the level of L5/S1 and presenting 4 weeks postoperatively with progressive foot drop. Although the initial concern was a postoperative lesion at L5, the cause for this delayed presentation was extrinsic compression of the CPN at the level of the fibular head by a tight-fitting below-knee thromboembolic deterrent stocking. Compression stockings are widely used in all branches of medicine and in the community. It is important to recognize this potential cause of progressive foot drop early as it is preventable by simple measures, which can significantly reduce morbidity.

Peroneal nerve palsy after compression stockings application

Peroneal nerve palsy can be caused by various etiology. We report unilateral peroneal nerve palsy after compression stockings application. A 64-year-old man underwent off-pump coronary bypass graft. Surgeon did not use saphenous vein for the bypass graft. Sedation was stopped after 3 h postoperative. After 16 h, for prophylaxis of deep vein thrombosis, knee-high elastic stocking was applied. After 1 h, he took off right stocking because of numbness but left stocking was kept. After 24 h postoperative, (8 h after stocking application) patient complained suddenly left foot drop. Manual muscle test revealed 0/5 of ankle dorsiflexion, ankle eversion, and toe extension. Sensory was decreased to 70% in lower half of anterolateral aspect of tibia, foot dorsum, and toes. Foot drop and sensory abnormality decreased in 3 weeks. Cardiac surgery patients already have many risk factors for peripheral neuropathy. Clinicians should be careful when applying stockings on those patients.