Nerve transfers to restore femoral nerve function following oncologic nerve resection

Abstract

Introduction Advances in the care of soft‐tissue tumors, including imaging capabilities and adjuvant radiation therapy, have broadened the indications and opportunities to pursue surgical limb salvage. However, peripheral nerve involvement and femoral nerve resection can still result in devastating functional outcomes. Nerve transfers offer a versatile solution to restore nerve function following tumor resection. Methods Two cases were identified by retrospective review. Patient and disease characteristics were gathered. Preoperative and postoperative motor function were assessed using the Medical Research Council Muscle Scale. Patient‐reported pain levels were assessed using the numeric rating scale. Results Nerve transfers from the obturator and sciatic nerve were employed to restore knee extension. Follow up for Case 1 was 24 months, 8 months for Case 2. In both patients, knee extension and stabilization of gait without bracing was restored. Patient also demonstrated 0/10 pain (an average improvement of 5 points) with decreased neuromodulator and pain medication use. Conclusion Nerve transfers can restore function and provide pain control benefits and ideally are performed at the time of tumor extirpation. This collaboration between oncologic and nerve surgeons will ultimately result in improved functional recovery and patient outcomes.

Hip Transposition Can Provide Early Walking Function After Periacetabular Tumor Resection: A Multicenter Study

“…In contrast, the median score in our delayed recovery group was 45% (range 13% to 57%) and longer-term improvement seemed uncertain. Thus, future studies should focus on improving the functional outcomes of this high-risk patient group, especially older patients or those with a sacrificed femoral nerve, from both a surgical viewpoint (potentially femoral nerve or muscle transfer) or rehabilitation improvement [2,19,25].…”

Contemporary Approaches to Peripheral Nerve Surgery

“…32 In the absence of obturator donor, tensor fascia latae (TFL) branch and fascicles of the sciatic can also be considered as donor nerves. [32][33][34][35][36][37] Evidence for the use of these nerve transfers is still limited; however, promising results in the younger patient population with early intervention suggest antigravity strength knee extension in the majority of patients. [32][33][34][35][36][37]…”

“…[32][33][34][35][36][37] Evidence for the use of these nerve transfers is still limited; however, promising results in the younger patient population with early intervention suggest antigravity strength knee extension in the majority of patients. [32][33][34][35][36][37]…”