Femoral neuropathy following abdominal hysterectorny FAROLIK M. GEORGY, !\!.D.

Fe111oml IU'IIropathy orcurs too often afin abdominal hyslt'l"tclom)'. This study im•e1lit;atrs po.1.1ihlr

of femoral neuropathy follcming abdominal hysterectomy is a disturbing complication to both patient and physician. Although total recoven is the rule, the disabling effect may last for several months. With today's costs of hospitalization and rehabilitation and with the growing meclicolegal ;m·areness, it sec·ms necessary f(>r every surgeon to recognin· this preventable complication. Femoral neuropathy is believed to occur far more frequentlv than is reported. The actual incidence is unknown. Five well-clocumentecl cases in the Allentown Hospital were encountered in the last two years (Table I). It is certain that several minm· femoral nerve impairments were either not reported by the patient or not rec~>rded b~ the physician. due to their short duration. This last fact is confirmed by personal communications 11·ith several of our staff gynecologists. This studv was directed tm1·ard investigation of the possible mechanisms of injury to the femoral nerve during -;urgery and possible ways of prevention. The study is based on analvsis of our cases, observations during surgery. and dissection of cadavers. Forty-eight similar cases 11cre reported before. It appears certain that femoral neuropathy occurs as a result of pressure exerted on the nerve in its course in the substance of the psoas m;~or muscle (Fig. 1). A brief review of the anatomy of the femoral nerve will aiel in understanding the pathogenesis of its injury. The femoral nerve arises from the dorsal rami of the anterior priman divisions of the second, third, and fourth lumbar \"ertebrae. Almost immediately on its

formation it penetrates the substance of the p~oas major muscle. It runs obliquelv to emerge at the lower lateral border of the psoas major. lt thenronH·s to lie in the groove between the psoas and iliacus muscles deep to the fascia iliaca. It emerges into the thigh lateral to the femoral canal. The nene gin·s motor su pplv to the iliacus, quadriceps. pectineus. and sartoriu-, muscles. Sensory branches supplY the anteronwdial ~tspect of the thigh and the medial aspect oft he leg. Tlw cxtcrnal iliac artery runs medial to the psoas major muscle.

THF occllRRE:--ICF

The femoral nerw is not included in the true pch is. lts injun as a result of the operative procedure itself is unlikely. When the femoral nenT 11as isolated in the cadaver and the retractor placed. \\C ohsern·d that the n1ost probable n1echanisin uf injury i~ ciilu_·r dircci pressure on the nerve proper bv the lateral blades o1· impingement of the nerve bet\\Ten the lateral pch·is \\·;til and the psoas muscle, ll"ith external pressure ahm-c the nerve on the muscle. The al tual site of femoral nene injun is a short segment of the nerve annroximatdv ..J. em. abow· the iiHTilinal lig·;nncnl. 1 1,

Femoral neuropathy following abdominal hysterectomy.

Femoral neuropathy occurs too often after abdominal hysterectomy. This study investigates possible mechanisms of injury to the femoral nerve and possi...
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