Femoral neuropathy secondary to the use of a self-retaining retractor. Report of three cases and review of the literature.

Abstract

Three recent cases of femoral neuropathy at our institution following colorectal surgery have been ascribed to the use of the self-retaining Bookwalter retractor. The pathophysiology of neural injury includes compression, stretch, transection, ligation, iliopsoas hematoma, ischemia, and cement encapsulation. The aim of this study is to provide a comprehensive review of femoral nerve anatomy and mechanism of retractor injury. The relationship of the femoral nerve to the lateral blade of the Bookwalter retractor was evaluated during colorectal surgery and in cadaveric dissections. The lateral blade of the self-retaining retractor was observed to either compress or impinge the intrapelvic portion of the femoral nerve. The incidence of postoperative femoral neuropathy is likely underestimated because a majority of cases are self-limited. This debilitating iatrogenic injury can be prevented with a thorough understanding of femoral nerve anatomy and careful placement of self-retaining retractor blades.