LFCN Surgery

Usually performed for the treatment of Meralgia Paresthetica. This is when the nerve that runs to the outside of the thigh, just below the hip and above the knee, is compressed or not functioning correctly. This nerve is called the Lateral Femoral Cutaneous Nerve (LFCN).

What causes the problem?

1. The sharp bend in the nerve may allow the nerve to be stretched and therefore damaged in the inguinal ligament.
2. Stretching of the nerve may be caused by being overweight, causing the nerve to lengthen in the thigh.
3. Compression of the nerve caused by overly tight clothing or belts can also be a cause.
4. Repetitive trauma to the nerve.
5. Constant pressure on the nerve in long face down surgery, usually spine surgery.
6. Often there is no specific cause.

What are the reasons for having the operation?

The commonest reason is that the symptoms in your leg have been causing significant discomfort, or that the symptoms are getting worse. Usually non-operative therapy has failed.

What are the types of surgery?

1. Trial steroid and local anaesthetic injection around the nerve. This may cause permanent improvement and is also diagnostic, allowing Mr. D'Urso to confirm the site of the nerve.
2. Decompression of the nerve in the inguinal ligament with a transverse cut in the thigh to get the nerve.
3. Division of the nerve at the inguinal ligament with a transverse cut in the thigh to get to the nerve. This usually is the best surgical alternative.

What operation is performed?

Prior to the consideration of surgery all patients will have a trial of injection of local anaesthetic and steroids around where the nerve normally is. This is done at a time prior to any surgery. This should send the nerve completely to sleep and usually relieves the pain. The sensation loss will be temporary but the relief of symptoms will commonly be prolonged and may be permanent. A small needle will be inserted around the nerve and the drugs injected.

The operation can be either division of the nerve or decompression. Usually Mr. D'Urso will try to decompress the nerve as the initial procedure. This is not as effective as division of the nerve but it gives a chance of maintaining sensation which will be lost with nerve division. The surgery can either be performed under a local or general anaesthetic. You may be admitted as a day patient and go home after the operation or be admitted the day before.

Regardless of the type of anaesthetic, you will not be qable to eat or drink from midnight before the operation.

What happens at the operation?

Firstly, the leg to be operated on is confirmed and the incision line is drawn on the skin at the groin. If the operation is under local anaesthetic then this will be injected into the wound at this time (a sedative is given by the anaesthetist to help the operation pass).

If under general anaesthetic, you will go off to sleep after the marking of the incision. The incision is then washed with antiseptic solution and the leg is covered with drapes to leave only the area of the incision exposed.

Mr. D'Urso then cuts through the skin and fat down to the first fascia layer. He will then cut through the fascia over the muscle and the nerve with a sharp scapel. The nerve is identified as it runs beneath this fascia. He follows the nerve up to the inguinal ligament and finds the point where it comes through. If the nerve is decompressed then this hole is opened up. If the nerve is to be divided then the nerve is lightly pulled on to pull it through the hole. It is then cut and the stump will withdraw back into the abdomen.

Mr. D'Urso then makes sure all the bleeding has stopped and sews the skin and the layer underneath back together. The wound is then covered with a dressing and you are then sent to the recovery room.

What happens next?

You will wake up in the recovery room and after about one hour you will be transferred to the ward. The nursing staff will be continously checking your pulse/blood pressure/limb strengths and sensation looking for any changes to indicate a complication. You will probably only need oral analgesia. Most people will be able to go home the same day. It is important that someone drives you home afterwards.

The sutures are usually removed about 7-12 days after the surgery if they are not dissovable.

What you should notify your doctor of after surgery?

1. Increasing pain in the wound/groin.
2. Fever.
3. Swelling or infection in the wound.

If the nerve is divided there will be a patch of numbness on the side of the leg. This will reduce over time but will not completely go away.

What happens when you go home?

1. The covering dressing should be changed second daily from the second day or if it gets wet.
2. You will have an early follow-up appointment to have your wound reviewed.
3. You must not run or stress the leg until you are advised you can do so by Mr. D'Urso.
4. It is important to keep the wound dry.
5. Mr. D'Urso will discuss driving and return to work with you.

What are the risks?

Please discuss these with Mr. D'Urso at your appointment.

The common risks are:

1. The nerve cannot always be found as it may come out in an unusual place. If you have had a result from the injection we can usually find the nerve.
2. Infection (treated with antibiotics).
3. Post-operative blood clot requiring drainage.
4. Nerve damage.
5. Wound pain.
6. Scar in the wound area.
7. Failure of symptoms to improve.

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