Femoral to Sciatic Nerve Transfers: A Cadaveric Feasibility Study
Pradeep K Attaluri, MD and Amgad Hanna, MD, University of Wisconsin, Madison, WI
Femoral to Sciatic Nerve Transfers: A Cadaveric Feasibility Study
Introduction:
Proximal sciatic nerve injuries are a challenge to treat due the limited options for donor nerves and the long distance needed for regeneration. Due to the sciatic nerve’s large cross-sectional area and overall length, proximal injury sites that preclude viable reconstruction with primary nerve grafts present anatomical challenges for nerve repair. Specifically, femoral to tibial and common peroneal nerve transfers have gained popularity due to the four femoral terminal motor branch candidates - the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. Inspired by these studies, we propose a novel reconstructive method for proximal sciatic nerve injury by directly transferring the femoral nerve motor branches to the tibial and common peroneal nerves without the need for interposition nerve grafting.
Methods:
In our cadaveric study using 10 cadaver limbs, we aimed to evaluate the feasibility of transferring the femoral nerve motor branches of the vastus medialis and vastus lateralis to the common peroneal and tibial components of sciatic nerve, respectively, without the need for interposition nerve graft. The femoral nerve branches of the vastus medialis and lateralis were exposed anteriorly. The sciatic nerve was exposed posteriorly and passed through a narrow window within adductor magnus and medial to the femur. The sciatic nerve was then neurolysed into its tibial and peroneal components. The peroneal nerve component was coapted to the vastus medialis branch and the tibial nerve component to the vastus lateralis without tension.
Results:
The results show that we were able to achieve a tensionless coaptation in all 10 cadaveric limbs without the need for interposition nerve grafting. On average, there was 6.85cm of overlap while coapting the vastus medialis branch to the common peroneal nerve and 4.4cm of overlap while coapting the vastus lateralis branch to the tibial nerve. Four total limbs required an intramuscular window through the adductor magnus to achieve a tensionless coaptation.
Conclusions:
By using the entire tibial and peroneal components of the sciatic nerve, we were able to gain more length and directly coapt the femoral nerve branches without utilizing interposition grafts. The disadvantage of this technique is suturing to a mixed nerve with motor and sensory components, which could compromise functional outcomes. Clinical application is needed to determine preliminary outcomes before widespread utilization of this technique.
Back to 2024 Abstracts