Femoral Nerve Transfers for Restoring TIbial Nerve Function
Emily M. Krauss, MSC MD, Michael J. Franco, MD, Rajiv P. Parikh, MD, Thomas H. Tung, MD, Amy M. Moore, MD.
Washington University School of Medicine, St. Louis, MO, USA.
Sciatic nerve injuries cause debilitating functional impairment, particularly when injury mechanism precludes reconstruction using primary grafting. The purpose of this study is to demonstrate anatomic feasibility of nerve transfers from distal femoral nerve branches to tibial nerve, and describe successful restoration of tibial nerve function in clinical practice using the described lower extremity nerve transfer.
Six cadaver legs were dissected for anatomic analysis and development of tension-free nerve transfers from femoral nerve branches to the tibial nerve. In two patients with complete sciatic nerve palsy, terminal branches of the femoral nerve supplying vastus medialis and vastus lateralis were transferred to medial and lateral gastrocnemius branches of the tibial nerve. Distal sensory transfer of the saphenous nerve to the sural nerve was also performed. Patients were clinically assessed for lower extremity motor and sensory recovery up to eighteen months postoperative.
Consistent branching patterns and anatomic landmarks were present in all dissection specimens, allowing for reliable identification, neurolysis, and capitation of donor femoral and saphenous nerve branches to the recipients. In the clinical population, patients obtained Medical Research Council (MRC) grade 3 and 3+ plantar flexion by eighteen months post-operatively. Improved strength was accompanied by improved ambulation in both patients, and a return to competitive sport in one patient. Sensory recovery was demonstrated in both patients by an advancing Tinel sign.
This study illustrates clinical success and anatomic reliability of femoral nerve to tibial nerve transfers after complete sciatic nerve injury.
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