Iatrogenic femoral nerve injury: a systematic review.

PURPOSE: Iatrogenic femoral nerve injury is a recognized complication of abdominal and pelvic surgery. It causes distress and disability and may lead to permanent motor and/or sensory sequelae. The aim of this systematic review was to explore the contemporary spectrum of this injury reported in the literature.

METHODS: A systematic review of iatrogenic femoral nerve injuries reported between 2000 and October 2010 was undertaken using the electronic databases Medline, PubMed, Cochrane Library, and Google Scholar. The context, frequency, mechanism of injury, and outcome were recorded. Relevant clinical and anatomical literature was reviewed to provide an overview of the surgical anatomy.

RESULTS: Iatrogenic femoral nerve injury is not rare, occurring as a complication of common abdominal, pelvic, and orthopedic operations and after femoral nerve blocks and femoral artery puncture. Mechanisms of injury are diverse and include direct trauma and ischemia from retraction or stretching of the nerve. Variant anatomy is very rarely the source of the problem. Although the prognosis in most cases is good some affected patients require nerve repair or grafting and some are left with permanent residual neurologic deficits.

CONCLUSIONS: A wider awareness of this complication, particularly the context in which it may occur, together with an appropriate understanding of the anatomy of the femoral nerve may help to reduce the frequency of this distressing and disabling iatrogenic complication.