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Axonal components of nerves innervating the lower limb
Udo Maierhofer, MD1; Louis Dannhausen, Medical Student1; Daniele Brunelli, Medical Student1; Christopher Festin, MD1; Vlad Tereshenko, MD1; Florian Johannes Jaklin, MD1; Olga Politikou, MD1; Matthias Luft, MD1; Lukas Reissig, MD2; Konstantin D Bergmeister, MD PhD1; Roland Blumer, PhD3; Oskar C Aszmann, MD4
1Medical University of Vienna, Vienna, Austria; 2Department of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; 3Systemic Anatomy, Medical University of Vienna, Vienna, Austria; 4Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria

Introduction: Nerve transfer surgery is a well-established and commonly used surgical treatment option for peripheral nerve injuries and root avulsion injuries when direct coaptation is not possible. The motor fiber count of the recipient as well as the donor nerve is an important prerequisite for surgical planning of nerve transfers. While a quantitative analysis of the brachial plexus’ motor and sensory axons has been recently reported, similar data for the innervation of the lower extremity does not exist. In this study we aimed to analyze the motor and sensory fiber count of nerves innervating the human lower limb.
Materials & Methods: The major peripheral nerves innervating the lower limb (femoral, obturator, tibial and common peroneal nerve) were investigated at multiple levels, reaching from the lumbosacral plexus to terminal muscular and sensory branches. Nerve samples were harvested in 10 human cadaver specimens within 24 hours post-mortem. The samples were then processed and subjected to a double immunofluorescence staining protocol using antibodies against choline-acetyltransferase (ChAT) and neurofilament (NF). NF labels all axons, while ChAT identifies motor axons, thus making it possible to distinguish motor and sensory axons in nerve cross sections.
Results: For the first time, our recently established double immunofluorescence staining protocol was successfully used on nerve samples harvested from cadaver specimens within 24 hours post-mortem. Our results demonstrate the axonal composition of the femoral nerve (total axons 75273 ± 6158, motor axons 5621 ± 303), the obturator nerve (total axons 20473 ± 2660, motor axons 2880 ± 505), the tibial nerve (total axons 70907 ± 11731, motor axons 6081 ± 1086), the common peroneal nerve (total axons 40393 ± 3742, motor axons 2133 ± 411) and their branches.
Conclusion: The presented data contributes to the advanced understanding of the axonal composition of peripheral nerves innervating the lower limb. Our results may help to estimate the axonal load of the donor and recipient nerve in nerve transfer surgery. This could greatly aid surgical planning and avoiding mismatching


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