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Neurotrophic Expression and Neuronal Response in the Spinal Cord Following Direct and Trans-Cutaneous Electrical Stimulation of the Mouse Sciatic Nerve
Anne-Marie Pion, MD; Eric Beaumont, PhD; Artur Kania, PhD; Jenny C. Lin, MD, PhD
Research Centre CHU-Sainte- Justine, University of Montreal, Montreal, QC, Canada
Femoral nerve injuries are devastating and result in loss of quadriceps function and impaired ambulation. While nerve transfers have become popular in restoring upper extremity function after brachial plexus injury, their use in lower extremity nerve injuries is rare. To determine the surgical options and feasibility of a distal motor nerve to femoral nerve transfer in the thigh for restoration of quadriceps function, an anatomical study was performed. Two clinical cases of these nerve transfers and assessment of their return of function is also reported.
Methods: In eight cadaveric lower limbs, the branching pattern and length of the femoral nerves to the quadriceps muscles, anterior obturator nerve, and the nerve to tensor fascia lata (TFL) were characterized. Two patients with femoral nerve palsies underwent direct nerve transfer in the thigh of the anterior obturator nerve to the femoral nerve branches of the rectus femoris and the vastus medialis muscles. One of these patients also received a nerve to TFL to vastus medialis muscle nerve transfer.
Results: A consistent reproducible pattern of femoral nerve branching was seen with minor variability. There is adequate length of both the recipient femoral nerve branches as well as the local donor motor nerves (anterior obturator and nerve to TFL) to perform a tensionless direct transfer in the thigh. In two patients, these transfers resulted in return of rectus femoris and vastus medialis innervation with restoration of active knee extension and improved ambulation. One patient has returned to running and jumping with minimal functional limitation of his affected limb.
Conclusion: This study confirms the anatomical feasibility and clinical success of direct distal motor nerve transfers in the thigh as a treatment option for the restoration of quadriceps function in cases of femoral nerve injury
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