A 20-year-old man presented to an outside hospital with bilateral femoral shaft fractures and left sciatic nerve palsy following a motorcycle accident. The femoral fractures were fixed on day 8 post-injury. The left sciatic nerve was surgically explored 7 days later, revealing a defect too large to reconstruct using a sural nerve graft. He was then referred to our hospital for further evaluation and treatment. At 15 weeks post-injury, delayed reconstruction using an ipsilateral common peroneal nerve graft was performed. Intra-operatively, the nerve defect length measured 13.5 cm. After dividing the sciatic nerve into its tibial and peroneal trunks, the peroneal trunk was harvested and used to reconstruct the tibial trunk using a double-cable graft technique. The patient’s postoperative course was uneventful. At a 2-year follow-up, he had achieved grade 4 plantar flexion. At 4 years postoperatively, plantar sensation was present, but Semmes–Weinstein testing showed loss of protective sensation. He was able to run and perform daily activities without requiring the use of an ankle-foot orthosis. The double-cable technique using an ipsilateral peroneal nerve graft may be considered as a salvage option for reconstructing large sciatic nerve defects when sural nerve grafting is not possible.
