Complete Femoral Nerve Transection with Sural Nerve Cable Graft in a 21-Month-Old Child

ABSTRACTSevere peripheral nerve injury occasionally requires urgent nerve grafting especially with significant separation of the proximal and distal ends of the injured nerve. Proper reinnervation to provide continued sensory and motor function is essential especially in the pediatric population. These patients would suffer lifelong disability without correction, yet have significantly improved regenerative capacity with prompt and effective management, making nerve grafts an ideal choice for complete nerve transection. This case report describes the successful sural nerve cable graft reinnervation of a transected femoral nerve in a 21-month-old male. This procedure was made difficult by severe trauma to the surrounding area with laceration of the femoral artery, significant separation of the femoral nerve ends, and the compact anatomy of such a young patient.

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Surgical treatment of lumbosacral plexus injuries

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.1.0064 ◽

2004 ◽

Vol 1 (1) ◽

pp. 64-71 ◽

Cited By ~ 44

Author(s):

Eva Maria Lang ◽

Jörg Borges ◽

Thomas Carlstedt

Keyword(s):

Cauda Equina ◽

Femoral Nerve ◽

Severe Trauma ◽

Lumbosacral Plexus ◽

Spinal Root ◽

Content Type ◽

Spinal Nerves ◽

Nerve Grafts ◽

Nerve Transfers ◽

Fine Print

Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment. Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed. Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.

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Neurophysiological studies of autogenous sural nerve grafts.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.41.8.677 ◽

1978 ◽

Vol 41 (8) ◽

pp. 677-683 ◽

Cited By ~ 21

Author(s):

R Tallis ◽

P Staniforth ◽

T R Fisher

Keyword(s):

Sural Nerve ◽

Nerve Grafts ◽

Neurophysiological Studies

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Does the Tibial and Sural Nerve Transection Model Represent Sympathetically Independent Pain?

Yonsei Medical Journal ◽

10.3349/ymj.2006.47.6.847 ◽

2006 ◽

Vol 47 (6) ◽

pp. 847 ◽

Cited By ~ 14

Author(s):

Dong Woo Han ◽

Tae Dong Kweon ◽

Ki Jun Kim ◽

Jong Seok Lee ◽

Chul Ho Chang ◽

...

Keyword(s):

Sural Nerve ◽

Nerve Transection

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A Retrospective Review of Femoral Nerve Block for Postoperative Analgesia After Knee Surgery in the Pediatric Population

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000113 ◽

2014 ◽

Vol 34 (4) ◽

pp. 459-461 ◽

Cited By ~ 13

Author(s):

Brian Schloss ◽

Tarun Bhalla ◽

Kevin Klingele ◽

Daniel Phillips ◽

Bradley Prestwich ◽

...

Keyword(s):

Nerve Block ◽

Postoperative Analgesia ◽

Retrospective Review ◽

Femoral Nerve Block ◽

Pediatric Population ◽

Femoral Nerve ◽

Knee Surgery

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The lateral femoral cutaneous nerve canal

Journal of Neurosurgery ◽

10.3171/2016.1.jns152262 ◽

2017 ◽

Vol 126 (3) ◽

pp. 972-978 ◽

Cited By ~ 12

Author(s):

Amgad Hanna

Keyword(s):

Iliac Crest ◽

Intraoperative Imaging ◽

Femoral Nerve ◽

Anatomical Variations ◽

Cutaneous Nerve ◽

Lateral Femoral Cutaneous Nerve ◽

Nerve Transection ◽

Meralgia Paresthetica ◽

Anterolateral Thigh ◽

Femoral Cutaneous Nerve

OBJECTIVE Meralgia paresthetica causes dysesthesias and burning in the anterolateral thigh. Surgical treatment includes nerve transection or decompression. Finding the nerve in surgery is very challenging. The author conducted a cadaveric study to better understand the variations in the anatomy of the lateral femoral cutaneous nerve (LFCN). METHODS Twenty embalmed cadavers were used for this study. The author studied the LFCN's relationship to different fascial planes, and the distance from the anterior superior iliac spine (ASIS). RESULTS A complete fascial canal was found to surround the nerve completely in all specimens. The canal starts at the inguinal ligament proximally and follows the nerve beyond its terminal branches. The nerve could be anywhere from 6.5 cm medial to the ASIS to 6 cm lateral to the ASIS. In the latter case, the nerve may lodge in a groove in the iliac crest. Other anatomical variations found were the LFCN arising from the femoral nerve, and a duplicated nerve. A thick nerve was found in 1 case in which it was riding over the ASIS. CONCLUSIONS The variability in the course of the LFCN can create difficulty in surgical exposure. The newly defined LFCN canal renders exposure even more challenging. This calls for high-resolution pre- or intraoperative imaging for better localization of the nerve.

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Stimulation of Neurite Outgrowth Using Autologous NGF Bound at the Surface of a Fibrous Substrate

Biomolecules ◽

10.3390/biom12010025 ◽

2021 ◽

Vol 12 (1) ◽

pp. 25

Author(s):

Marta R. Casanova ◽

Rui L. Reis ◽

Albino Martins ◽

Nuno M. Neves

Keyword(s):

Nerve Growth Factor ◽

Neurite Outgrowth ◽

Gold Standard ◽

Peripheral Nerve Injury ◽

Neurite Growth ◽

Nerve Grafts ◽

Clinical Challenge ◽

Pheochromocytoma Pc12 ◽

Medium Supplementation ◽

Stimulation Of

Peripheral nerve injury still remains a major clinical challenge, since the available solutions lead to dysfunctional nerve regeneration. Even though autologous nerve grafts are the gold standard, tissue engineered nerve guidance grafts are valid alternatives. Nerve growth factor (NGF) is the most potent neurotrophic factor. The development of a nerve guidance graft able to locally potentiate the interaction between injured neurons and autologous NGF would be a safer and more effective alternative to grafts that just release NGF. Herein, a biofunctional electrospun fibrous mesh (eFM) was developed through the selective retrieval of NGF from rat blood plasma. The neurite outgrowth induced by the eFM-NGF systems was assessed by culturing rat pheochromocytoma (PC12) cells for 7 days, without medium supplementation. The biological results showed that this NGF delivery system stimulates neuronal differentiation, enhancing the neurite growth more than the control condition.

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Functional Outcomes of Multiple Sural Nerve Grafts for Facial Nerve Defects after Tumor-Ablative Surgery

Archives of Plastic Surgery ◽

10.5999/aps.2015.42.4.461 ◽

2015 ◽

Vol 42 (4) ◽

pp. 461 ◽

Cited By ~ 16

Author(s):

Myung Chul Lee ◽

Dae Hee Kim ◽

Yeo Reum Jeon ◽

Dong Kyun Rah ◽

Dae Hyun Lew ◽

...

Keyword(s):

Facial Nerve ◽

Functional Outcomes ◽

Sural Nerve ◽

Nerve Grafts ◽

Ablative Surgery

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4.7-T diffusion tensor imaging of acute traumatic peripheral nerve injury

Neurosurgical FOCUS ◽

10.3171/2015.6.focus1590 ◽

2015 ◽

Vol 39 (3) ◽

pp. E9 ◽

Cited By ~ 25

Author(s):

Richard B. Boyer ◽

Nathaniel D. Kelm ◽

D. Colton Riley ◽

Kevin W. Sexton ◽

Alonda C. Pollins ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

High Resolution ◽

Peripheral Nerve ◽

Nerve Injury ◽

Peripheral Nerve Injury ◽

Diffusion Tensor ◽

Ex Vivo ◽

Nerve Fibers ◽

Nerve Transection ◽

Nerve Injuries

Diagnosis and management of peripheral nerve injury is complicated by the inability to assess microstructural features of injured nerve fibers via clinical examination and electrophysiology. Diffusion tensor imaging (DTI) has been shown to accurately detect nerve injury and regeneration in crush models of peripheral nerve injury, but no prior studies have been conducted on nerve transection, a surgical emergency that can lead to permanent weakness or paralysis. Acute sciatic nerve injuries were performed microsurgically to produce multiple grades of nerve transection in rats that were harvested 1 hour after surgery. High-resolution diffusion tensor images from ex vivo sciatic nerves were obtained using diffusion-weighted spin-echo acquisitions at 4.7 T. Fractional anisotropy was significantly reduced at the injury sites of transected rats compared with sham rats. Additionally, minor eigenvalues and radial diffusivity were profoundly elevated at all injury sites and were negatively correlated to the degree of injury. Diffusion tensor tractography showed discontinuities at all injury sites and significantly reduced continuous tract counts. These findings demonstrate that high-resolution DTI is a promising tool for acute diagnosis and grading of traumatic peripheral nerve injuries.

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