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

  • Original Article - Peripheral Nerves
  • Published:
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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.

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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

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Funding

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).

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Author notes

  1. Depeng Meng and Huihao Chen contributed equally to the manuscriptand should be considered cofirst authors.

Authors and Affiliations

  1. Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, People’s Republic of China

    Depeng Meng, Huihao Chen, Yaofa Lin, Haodong Lin & Chunlin Hou

Authors
  1. Depeng Meng
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  2. Huihao Chen
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  3. Yaofa Lin
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  4. Haodong Lin
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  5. Chunlin Hou
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Corresponding author

Correspondence to Haodong Lin.

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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.

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Comments

Dr. Meng and his colleagues at the Second Military Medical University in Shanghai have provided us with a beautiful cadaver dissection demonstrating the feasibility of using nerve transpositions from the femoral nerve to restore function in a patient with an irreparable high sciatic nerve injury. The anatomy of those transpositions is very nicely demonstrated in the accompanying figures.

While I remain sceptical about the efficacy of sural nerve grafts more than seven centimetres, the authors have provided us with reference of cases in which longer sural nerve grafts have restored function. I am very interested in reading about the authors' results applying this technique to patients.

Allan Friedman

NC, USA

An interesting proximal femoral nerve to distal sciatic nerve transfer option in the setting of proximal injuries to the lumbosacal plexus and/or proximal sciatic nerve. It will require further validation in animals and if successful eventually in patients.

Michel Kliot

CA, USA

This article is part of the Topical Collection on Peripheral Nerves

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Meng, D., Chen, H., Lin, Y. et al. Transferring of femoral nerve motor branches for high-level sciatic nerve injury: a cadaver feasibility study. Acta Neurochir 161, 279–286 (2019). https://doi.org/10.1007/s00701-018-3746-y

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  • DOI: https://doi.org/10.1007/s00701-018-3746-y

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