Advertisement

Transferring of femoral nerve motor branches for high-level sciatic nerve injury: a cadaver feasibility study

  • Depeng Meng
  • Huihao Chen
  • Yaofa Lin
  • Haodong LinEmail author
  • Chunlin Hou
Original Article - Peripheral Nerves
  • 42 Downloads
Part of the following topical collections:
  1. Peripheral Nerves

Abstract

Background

Sciatic nerve injuries cause significant disability. We propose here a novel reconstructive procedure of transferring the motor branches of the femoral nerve as donor nerves to reconstruct both the peroneal and tibial nerve function as a novel approach to treat high sciatic nerve injury.

Methods

The autopsies of donor nerves (vastus lateralis nerve branch (VLN), vastus medialis nerve branch (VMN), saphenous nerve (SAN)) and respective recipient nerves (deep peroneal nerve branch (DPN), medial gastrocnemius nerve branch (MGN), sural nerve (SN)) were conducted in six fresh-frozen lower limbs. The distance between the origin or bifurcation points of the nerves to the head of fibula and the diameter of the end at the coaptation site were measured. The feasibility of tensionless direct suturing or grafting between the donor nerves and the recipient was evaluated. Finally, the nerve end at the coaptation site was harvested for observation with toluidine blue staining and nerve fiber count.

Results

The mean diameter of the VMN, VLN, MGN, DPN, SAN, and SN nerves were 1.5 ± 0.1, 1.4 ± 0.1, 1.3 ± 0.1, 2.3 ± 0.1, 2.1 ± 0.3, and 1.3 ± 0.2 mm, respectively. Histological observation showed that the abovementioned six nerve bundles had a respective nerve fiber number of 392 ± 27, 205 ± 520, 219 ± 67, 394 ± 50, 308 ± 77, and 335 ± 49. A total of 5/6 specimens needed grafting for a length ranging from 5 to 15 cm to bridge the VMN–MGN, 6/6 needed a graft length of 10–20 cm for VLN–DPN bridging, and 2/6 needed a graft length of 0–4 cm for SAN–SN bridging.

Conclusion

The study demonstrated the feasibility of the transferring femoral nerve branches to sciatic nerve branches to restore the function for sciatic injury.

Keywords

Nerve transfer Sciatic nerve injury Femoral nerve Anatomic feasibility 

Abbreviations

VMN

vastus medialis nerve branch

VLN

vastus lateralis nerve branch

MGN

medial gastrocnemius nerve branch

LGN

lateral gastrocnemius nerve branch

DPN

deep peroneal nerve branch

SPN

superficial peroneal nerve branch

SAN

saphenous nerve

SN

sural nerve

MSN

medial sural nerve

LSN

lateral sural nerve

TN

tibial nerve

CPN

common peroneal nerve

MRC

medical research council

Notes

Funding information

This study was funded by the National Natural Scientific Foundation of China (grant number 81572146), the Program of Outstanding Medical Talent of Shanghai Municipal Health Bureau (grant number 2017BR034), the Shuguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission (grant number 15SG34), and the Project of Research Doctor of Changzheng Hospital (grant number 201712).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human specimens were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Bosnjak RF, Dolenc VV, Sepe A, Demsar F (1992) Force, fatigue, and the cross-sectional area of wrist extensor muscles after radial nerve grafting. Neurosurgery 31(6):1035–1041 discussion 1041-1032PubMedGoogle Scholar
  2. 2.
    Brunner R, Rutz E (2013) Biomechanics and muscle function during gait. J Child Orthop 7(5):367–371CrossRefGoogle Scholar
  3. 3.
    Burks SS, Levi DJ, Hayes S, Levi AD (2014) Challenges in sciatic nerve repair: anatomical considerations. J Neurosurg 121(1):210–218CrossRefGoogle Scholar
  4. 4.
    Fisher TR, McGeoch CM (1985) Severe injuries of the radial nerve treated by sural nerve grafting. Injury 16(6):411–412CrossRefGoogle Scholar
  5. 5.
    Flores LP, Martins RS, Siqueira MG (2013) Clinical results of transferring a motor branch of the tibial nerve to the deep peroneal nerve for treatment of foot drop. Neurosurgery 73(4):609–615 discussion 615-606CrossRefGoogle Scholar
  6. 6.
    Giuffre JL, Bishop AT, Spinner RJ, Levy BA, Shin AY (2012) Partial tibial nerve transfer to the tibialis anterior motor branch to treat peroneal nerve injury after knee trauma. Clin Orthop Relat Res 470(3):779–790CrossRefGoogle Scholar
  7. 7.
    Iyer VG (2015) Iatrogenic injury to the sciatic nerve during surgical repair of proximal hamstring avulsion. Muscle Nerve 52(3):465–466CrossRefGoogle Scholar
  8. 8.
    Kallio PK, Vastamaki M, Solonen KA (1993) The results of secondary microsurgical repair of radial nerve in 33 patients. J Hand Surg Br 18(3):320–322CrossRefGoogle Scholar
  9. 9.
    Kimmel SA, Schwartz MH (2006) A baseline of dynamic muscle function during gait. Gait Posture 23(2):211–221CrossRefGoogle Scholar
  10. 10.
    Korompilias AV, Payatakes AH, Beris AE, Vekris MD, Afendras GD, Soucacos PN (2006) Sciatic and peroneal nerve injuries. Microsurgery 26(4):288–294CrossRefGoogle Scholar
  11. 11.
    Koshima I, Nanba Y, Tsutsui T, Takahashi Y (2003) Deep peroneal nerve transfer for established plantar sensory loss. J Reconstr Microsurg 19(7):451–454CrossRefGoogle Scholar
  12. 12.
    Lee YH, Chung MS, Gong HS, Chung JY, Park JH, Baek GH (2008) Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. J Hand Surg Am 33(1):83–86CrossRefGoogle Scholar
  13. 13.
    Lin H, Hou C, Chen A (2011) Reconstructed bladder innervation above the level of spinal cord injury to produce urination by abdomen-to-bladder reflex contractions. J Neurosurg Spine 14(6):799–802CrossRefGoogle Scholar
  14. 14.
    Liu G, Jiang R, Jin Y (2014) Sciatic nerve injury repair: a visualized analysis of research fronts and development trends. Neural Regen Res 9(18):1716–1722CrossRefGoogle Scholar
  15. 15.
    Moore AM, Krauss EM, Parikh RP, Franco MJ, Tung TH (2018) Femoral nerve transfers for restoring tibial nerve function: an anatomical study and clinical correlation: a report of 2 cases. J Neurosurg 129(4):1024–1033CrossRefGoogle Scholar
  16. 16.
    Murovic JA (2009) Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions. Neurosurgery 65(4 Suppl):A18–A23CrossRefGoogle Scholar
  17. 17.
    Nath RK, Lyons AB, Paizi M (2008) Successful management of foot drop by nerve transfers to the deep peroneal nerve. J Reconstr Microsurg 24(6):419–427CrossRefGoogle Scholar
  18. 18.
    Ray WZ, Chang J, Hawasli A, Wilson TJ, Yang L (2016) Motor nerve transfers: a comprehensive review. Neurosurgery 78(1):1–26CrossRefGoogle Scholar
  19. 19.
    Shergill G, Bonney G, Munshi P, Birch R (2001) The radial and posterior interosseous nerves. Results fo 260 repairs. J Bone Joint Surg Br 83(5):646–649CrossRefGoogle Scholar
  20. 20.
    Steinau HU, Tofaute A, Huellmann K et al (2011) Tendon transfers for drop foot correction: long-term results including quality of life assessment, and dynamometric and pedobarographic measurements. Arch Orthop Trauma Surg 131(7):903–910CrossRefGoogle Scholar
  21. 21.
    Wang GB, Yu AP, Ng CY et al (2018) Contralateral C7 to C7 nerve root transfer in reconstruction for treatment of total brachial plexus palsy: anatomical basis and preliminary clinical results. J Neurosurg Spine:1–9Google Scholar
  22. 22.
    Wootten ME, Kadaba MP, Cochran GV (1990) Dynamic electromyography. II. Normal patterns during gait. J Orthop Res 8(2):259–265CrossRefGoogle Scholar
  23. 23.
    Yin G, Chen H, Hou C, Xiao J, Lin H (2016) Obturator nerve transfer to the branch of the tibial nerve innervating the gastrocnemius muscle for the treatment of sacral plexus nerve injury. Neurosurgery 78(4):546–551CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Depeng Meng
    • 1
  • Huihao Chen
    • 1
  • Yaofa Lin
    • 1
  • Haodong Lin
    • 1
    Email author
  • Chunlin Hou
    • 1
  1. 1.Department of Orthopedics, Changzheng HospitalSecond Military Medical UniversityShanghaiPeople’s Republic of China

Personalised recommendations