Meralgia paresthetica resulting from iatrogenic ligation of the lateral femoral cutaneous nerve: illustrative case.

backgroundThe lateral femoral cutaneous nerve (LFCN) is susceptible to entrapment arising from diverse pathological mechanisms, leading to the clinical condition termed meralgia paresthetica. Common etiologies include compression beneath the inguinal ligament, medical causes of mononeuropathy, and iatrogenic injury during surgical intervention. OBSERVATIONS: The authors present the case of a 27-year-old military veteran who presented with a 3-year history of right anterolateral thigh pain that he described as excruciating and exacerbated by minimal touch. Six months prior to the onset of symptoms, the patient sustained a blast injury to the groin during combat, and his wound was managed by a field surgeon. Surgical exploration revealed that the LFCN was tightly ligated by a nonabsorbable suture at the level of the inguinal ligament. Gentle incision of the suture facilitated nerve decompression. Examination of the nerve revealed circumferential indentations and localized atrophy at the site of constriction, although its continuity was maintained. The patient had a smooth recovery, with symptom resolution. He was followed for 1 year and showed no new symptoms. LESSONS: Iatrogenic ligation of the LFCN by a nonabsorbable suture represents a unique cause. Thorough assessment and a high clinical suspicion are crucial for determining the necessity of surgical exploration and neural decompression. Excision of the suture results in adequate decompression. https://thejns.org/doi/10.3171/CASE25436.