Obturator Nerve Transfer as an Option for Femoral Nerve Repair

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE375-onsE375 ◽  
Author(s):  
Ashley A. Campbell ◽  
Frederic E. Eckhauser ◽  
Allan Belzberg ◽  
James N. Campbell
Keyword(s):  
Nerve Repair ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Nerve Lesion ◽  
Distal Stump ◽  
Post Injury ◽  
Nerve Transfers ◽  
Important Addition ◽  
Quadriceps Function

Abstract OBJECTIVE Nerve transfers have proved to be an important addition to the armamentarium in the repair of brachial plexus lesions, but have been used sparingly for lower extremity nerve repair. Here, we present what is believed to be the first description of a successful transfer of the obturator nerve to the femoral nerve. CLINICAL PRESENTATION A 45-year-old woman presented with a complete femoral nerve lesion after removal of a large (15-cm) schwannoma of the retroperitoneum involving the lumbar plexus. INTERVENTION The obturator nerve was transferred to the distal stump of the femoral nerve in the retroperitoneal space at the inguinal ligament three months post-injury. At 2 years post-repair, the patient demonstrated 4 out of 5 return (Medical Research Council grade) of quadriceps function and was able to walk nearly normally. CONCLUSION In cases in which there are extensive gaps in the femoral nerve, transfer of the obturator nerve provides an option to traditional nerve graft repair.

Nerve transfers for femoral nerve palsy: an updated approach and surgical technique

2021 ◽  
pp. 1-11
Author(s):  
Blair R. Peters ◽  
Austin Y. Ha ◽  
Amy M. Moore ◽  
Thomas H. Tung
Keyword(s):  
Pain Score ◽  
Nerve Palsy ◽  
Femoral Nerve ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Knee Extension ◽  
Lower Extremity Function ◽  
Nerve Decompression ◽  
Nerve Transfers ◽  
Femoral Nerve Palsy

OBJECTIVE Femoral nerve palsy results in significant impairment of lower extremity function due to the loss of quadriceps muscle function. The authors have previously described their techniques utilizing the anterior obturator and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. In the current study, the authors discuss their updated techniques, results, and approach to partial and complete femoral nerve palsies using femoral nerve decompression and nerve transfers. METHODS They conducted a retrospective review of patients with femoral nerve palsies treated with their technique at the Washington University School of Medicine in 2008–2019. Primary outcomes were active knee extension Medical Research Council (MRC) grades and visual analog scale (VAS) pain scores. RESULTS Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression and nerve transfer: 4 with end-to-end (ETE) nerve transfers, 6 with supercharged end-to-side (SETS) transfers, and 4 with ETE and SETS transfers, using the anterior branch of the obturator nerve, the sartorius branches, or a combination of both. The median preoperative knee extension MRC grade was 2 (range 0–3). The average preoperative VAS pain score was 5.2 (range 1–9). Postoperatively, all patients attained an MRC grade 4 or greater and subjectively noted improved strength and muscle bulk and more natural gait. The average postoperative pain score was 2.3 (range 0–6), a statistically significant improvement (p = 0.001). CONCLUSIONS Until recently, few treatments were available for high femoral nerve palsy. A treatment strategy involving femoral nerve decompression and nerve transfers allows for meaningful functional recovery and pain relief in cases of partial and total femoral nerve palsy. An algorithm for the management of partial and complete femoral nerve palsies and a detailed description of surgical techniques are presented.

scholarly journals Successful Nerve Transfers for Traumatic Brachial Plexus Palsy in a Septuagenarian

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. NP30-NP33 ◽  
Author(s):  
Parker H. Johnsen ◽  
Scott W. Wolfe
Keyword(s):  
Brachial Plexus ◽  
Older Patients ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Elderly ◽  
Suprascapular Nerve ◽  
Brachial Plexus Palsy ◽  
Nerve Reconstruction ◽  
Post Injury ◽  
Nerve Transfers

Background: Conventional wisdom and the available literature demonstrate compromised outcomes following nerve reconstruction for traumatic brachial plexus palsy in the elderly. We present a 74-year-old male who was reconstructed with multiple nerve transfers for brachial plexus palsy after a ski accident. Methods: Triceps to axillary nerve transfer, spinal accessory to suprascapular nerve transfer, and ulnar to musculocutaneous nerve transfer were performed 16 weeks post injury. Results: At 11 years post-op, the patient could abduct to 65° and forward flex at M4 strength, limited only by painful glenohumeral arthritis. Elbow flexion was M5- at both the biceps and brachialis, and bulk and tone were nearly symmetrical with the opposite side. Eleven-year electrodiagnostic studies demonstrated reinnervation and improved motor unit recruitment all affected muscles. Conclusion: This case questions the widely held dogma that older patients who undergo brachial plexus reconstruction do poorly. Given the short reinnervation distance and optimal donor nerve health, nerve transfers may be an excellent option for healthy older patients with traumatic brachial plexus palsy.

Future Perspectives in the Management of Nerve Injuries

2018 ◽  
Vol 34 (09) ◽  
pp. 672-674 ◽  
Author(s):  
Susan Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Functional Results ◽  
White Paper ◽  
Nerve Graft ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
Nerve Transfers ◽  
Reconstructive Microsurgery

Aim The author presents a solicited “white paper” outlining her perspective on the role of nerve transfers in the management of nerve injuries. Methods PubMed/MEDLINE and EMBASE databases were evaluated to compare nerve graft and nerve transfer. An evaluation of the scientific literature by review of index articles was also performed to compare the number of overall clinical publications of nerve repair, nerve graft, and nerve transfer. Finally, a survey regarding the prevalence of nerve transfer surgery was administrated to the World Society of Reconstructive Microsurgery (WSRM) results. Results Both nerve graft and transfer can generate functional results and the relative success of graft versus transfer depended on the function to be restored and the specific transfers used. Beginning in the early 1990s, there has been a rapid increase from baseline of nerve transfer publications such that clinical nerve transfer publication now exceeds those of nerve repair or nerve graft. Sixty-two responses were received from WSRM membership. These surgeons reported their frequency of “usually or always using nerve transfers for repairing brachial plexus injuries as 68%, radial nerves as 27%, median as 25%, and ulnar as 33%. They reported using nerve transfers” sometimes for brachial plexus 18%, radial nerve 30%, median nerve 34%, ulnar nerve 35%. Conclusion Taken together this evidence suggests that nerve transfers do offer an alternative technique along with tendon transfers, nerve repair, and nerve grafts.

scholarly journals Nerve Transfers for Restoring Elbow Flexion in Brachial Plexus Palsy

2021 ◽  
Author(s):  
Teodor Stamate ◽  
Dan Cristian Moraru
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Distal Stump ◽  
Brachial Plexus Palsy ◽  
Nerve Transfers ◽  
Pectoral Nerve ◽  
Intercostal Nerves ◽  
Thoracodorsal Nerve

Nerve transfers (NT) consist in sectioning a donor nerve and connecting it to the distal stump of a recipient unrepairable nerve. For elbow flexion restoration in brachial plexus palsy (BPP) we used different NT: 1) GF motor Ulnar Nerve to Biceps nerve (Oberlin technique), 2) Double fascicular median/ulnar to biceps/brachialis nerve transfer (Mackinnon), 3) InterCostal Nerves (ICN) to MCN (+/− nerve graft), 4) Medial Pectoral Nerve (MPN) to MCN, 5) ThoracoDorsal Nerve (TDN) to MCN, 6) Spinal Accessory Nerve (SAN) to MCN transfer, 7) Phrenic Nerve (PhN) to MCN, 8) Cervical Plexus C3-C4 to MCN and 9) Contralateral C7 (CC7). I want to present my personal experience using the phrenic nerve (PhN), the intercostal nerves (ICN) and Oberlin’s technique. The aim of this retrospective study is to evaluate the results of this procedure in BPP. NT is an important goal in BPP. ICN transfer into the nerve of biceps for elbow flexion recovery is a reliable procedure in BPP. ICN transfer for triceps offers a positive alternative (Carroll transposition). Oberlin technique is simple and offers better results in a shorter amount of time and is an effective and safe option.

Axillary nerve repair by triceps motor branch transfer through an axillary access: anatomical basis and clinical results

2007 ◽  
Vol 107 (2) ◽  
pp. 370-377 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Paulo Roberto Kechele ◽  
Marcos Antonio Santos ◽  
Hamilton Duarte ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Motor Nerve ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Clinical Results ◽  
Axillary Nerve ◽  
Surgical Anatomy ◽  
Motor Branch ◽  
Nerve Transfers ◽  
Anatomical Basis ◽  
Long Head

Object Grafting or nerve transfers to the axillary nerve have been performed using a deltopectoral approach and/or a posterior arm approach. In this report, the surgical anatomy of the axillary nerve was studied with the goal of repairing the nerve through an axillary access. Methods The axillary nerve was bilaterally dissected in 10 embalmed cadavers to study its variations. Three patients with axillary nerve injuries then underwent surgical repair through an axillary access; the axillary nerve was repaired by transfer of the triceps long head motor branch. Results At the lateral margin of the subscapularis muscle, the axillary nerve was found in the center of a triangle bounded medially by the subscapular artery, laterally by the latissimus dorsi tendon, and cephalad by the posterior circumflex humeral artery. At the entrance of the quadrangular space, the axillary nerve divisions were loosely connected to each other, and could be clearly separated and correctly identified. Surgery for the axillary nerve repair through the axillary access was straightforward. Eighteen months after surgery, all three patients had recovered deltoid strength to a score of M4 on the Medical Research Council scale and had improved abduction strength by 50%. No deficit was evident in elbow extension. Conclusions The axillary nerve and its branches can be safely dissected and repaired by triceps motor nerve transfer through an axillary access.

Contralateral Obturator Nerve to Femoral Nerve Transfer for Restoration of Knee Extension After Acute Flaccid Myelitis

2019 ◽  
Vol 9 (4) ◽  
pp. e0073-e0073 ◽  
Author(s):  
Kazuteru Doi ◽  
Sei Haw Sem ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto ◽  
Kota Hayashi ◽  
...  
Keyword(s):  
Femoral Nerve ◽  
Nerve Transfer ◽  
Knee Extension ◽  
Obturator Nerve ◽  
Acute Flaccid Myelitis

Nerve transfers for peripheral nerve injury in the upper limb

2019 ◽  
Vol 101-B (2) ◽  
pp. 124-131 ◽  
Author(s):  
J. Isaacs ◽  
A. R. Cochran
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Upper Limb ◽  
Nerve Repair ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Axillary Nerve ◽  
Nerve Transfers ◽  
Sensory Recovery ◽  
Potential Benefits

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.

Contralateral obturator nerve transfer for femoral nerve restoration: a case report

2020 ◽  
pp. 1-5
Author(s):  
Yu Cao ◽  
Yuehong Li ◽  
Youlai Zhang ◽  
Shulin Li ◽  
Junjian Jiang ◽  
...  
Keyword(s):  
Case Report ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve

Ultrasound-Guided Needle Localization Wires in Peripheral Nerve Injuries With Long Segmental Defects: Technical Case Report

2020 ◽  
Vol 20 (1) ◽  
pp. E60-E65
Author(s):  
Anthony Diaz ◽  
S Shelby Burks ◽  
Jean Jose ◽  
Allan D Levi
Keyword(s):  
Case Report ◽  
Peripheral Nerve ◽  
Nerve Repair ◽  
Femoral Nerve ◽  
Severe Injury ◽  
Distal Stump ◽  
Segmental Defect ◽  
Wire Localization ◽  
Musculoskeletal Radiology ◽  
Needle Localization

Abstract BACKGROUND AND IMPORTANCE In cases of severe nerve trauma with significant local soft tissue damage, identification and subsequent repair of nerve stumps can pose a technical challenge. Ultrasound (US) localization in peripheral nerve surgery has recently become popular. We present a case report illustrating the use of needle-wire localization systems to identify proximal and several distal branches of an injured femoral nerve with a large segmental defect in order to illustrate how such techniques can be used to make surgical repair more efficient, particularly with identifying the distal stump(s). CLINICAL PRESENTATION We illustrate a case of a 16-yr-old female involved in a traumatic accident that lead to a severe injury of the femoral nerve and artery. The patient presented with a 7.3-cm defect between the proximal and distal aspect of the femoral nerve and its branches, respectively. High-resolution US was used to identify the proximal, large femoral nerve, and 3 distal stumps. By enlisting our musculoskeletal radiology team, we were able to trace distal branches of the femoral nerve and see their target muscles. Three separate US flexible needles were used to locate small muscular branches of the femoral nerve and 1 to locate the proximal stump. Intraoperatively, the localization wires allowed for safe and efficient dissection of proximal and distal nerve stumps in a significantly scarred and edematous plane. CONCLUSION US-guided needle-wire localization has shown promise in identifying the distal stumps and minimizing tissue dissection. Preoperative US guidance significantly aided in nerve repair for this severe injury without increasing morbidity.

Obturator Nerve Transfer for Femoral Nerve Reconstruction

2012 ◽  
Vol 130 (5) ◽  
pp. 1066-1074 ◽  
Author(s):  
Thomas H. Tung ◽  
Albert Chao ◽  
Amy M. Moore
Keyword(s):  
Femoral Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Nerve Reconstruction
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