Different Surgical Reconstructions for Femoral Nerve Injury

Cao, Yu; Li, Yuehong; Zhang, Youlai; Li, Shulin; Jiang, Junjian; Gu, Yajia; Xu, Liang

doi:10.1097/sap.0000000000002371

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Four studies (n = 29) report outcomes for patients undergoing sural nerve grafting for isolated femoral nerve injuries. 15,48,50,56 In all cases, preoperative knee extension was absent. In one study, 23 patients were followed after surgery, with 12 recovering MRC grade 3 knee extension.…”

Section: Nerve Graftingmentioning

confidence: 90%

“…50 Six patients from the other three studies had more detailed preoperative and follow-up information. 15,48,56 For these patients, the mean preoperative interval was 3.3 + 1.2 months. The mean graft length (n = 6) used during surgery was 7.0 + 4.4 centimeters (cm).…”

Section: Nerve Graftingmentioning

confidence: 99%

“…Nine studies (n = 14) report outcomes for patients undergoing nerve transfers for isolated femoral nerve injuries. [15][16][17]23,24,26,29,60,61 Two of these studies also describe cadaver data and anatomic feasibility assessments. 60,61 In all patients, preoperative knee extension was absent, with several patients also demonstrating weakened hip flexion.…”

Section: Nerve Transfermentioning

confidence: 99%

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Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Nichols

Fenton

Cox

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Nerve reconstruction techniques for lumbosacral plexus (LSP) injuries vary. There are no clear treatment guidelines available, and summative evaluations of the literature discussing these surgeries are lacking. For these reasons, this investigation aimed to systematically review and consolidate all available literature discussing surgical interventions for LSP injuries and cohesively present patient-reported and objective postoperative outcomes. Methods: The authors conducted a systematic review using PubMed, Embase, Web of Science, ProQuest Dissertations and Theses Global (via Proquest.com), and ClinicalTrials.gov databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After title and abstract screening, identified articles were read in full and selected for inclusion based on prespecified criteria. Results: Our literature search identified 8683 potential citations, and after duplicate removal, abstract screening, and full-text review, 62 studies remained meeting inclusion and exclusion criteria. Outcomes were extracted according to the location of injury and type of surgical repair. Injuries were classified into isolated femoral nerve injuries, isolated obturator nerve injuries, isolated sciatic nerve injuries, and multilevel LSP injuries. Surgical treatment was further classified into exploration with neurolysis, direct repair, nerve grafting, and nerve transfer surgery. Conclusions: Although results vary based on the location of the injury and the surgical technique used, nerve grafts and transfers demonstrated reasonable success in improving functional and pain outcomes. Overall, isolated femoral and obturator nerve injuries had the best outcomes reported with surgical treatment. Furthermore, incomplete sciatic nerve and multilevel LSP injuries had more reported surgical options and better outcomes than complete sciatic nerve injuries.

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Section: Nerve Graftingmentioning

confidence: 90%

Section: Nerve Graftingmentioning

confidence: 99%

Section: Nerve Transfermentioning

confidence: 99%

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Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Nichols

Fenton

Cox

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…Nerve grafts can either entail an end-to-end nerve suture or suturing an autologous donor nerve to replace the damaged portion of the recipient nerve [ 108 , 109 ]. Various case reports highlight the effectiveness of this strategy, namely restoring the functionality of the femoral, obturator, and sciatic nerves, as well as for multilevel injuries involving nerve roots [ 102 , 103 , 107 , 110 , 111 ]. Across these various procedures, it was reported that related motor and sensory function was successfully restored, including hip adduction, hip flexion, and knee extension [ 102 , 103 , 107 , 110 , 111 ].…”

Section: Treatment and Managementmentioning

confidence: 99%

Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies

et al. 2023

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Clinicians have managed and treated lower back pain since the earliest days of practice. Historically, lower back pain and its accompanying symptoms of radiating leg pain and muscle weakness have been recognized to be due to any of the various lumbar spine pathologies that lead to the compression of the lumbar nerves at the root, the most common of which is the radiculopathy known as sciatica. More recently, however, with the increased rise in chronic diseases, the importance of differentially diagnosing a similarly presenting pathology, known as lumbosacral plexopathy, cannot be understated. Given the similar clinical presentation of lumbar spine pathologies and lumbosacral plexopathies, it can be difficult to differentiate these two diagnoses in the clinical setting. Resultingly, the inappropriate diagnosis of either pathology can result in ineffective clinical management. Thus, this review aims to aid in the clinical differentiation between lumbar spine pathology and lumbosacral plexopathy. Specifically, this paper delves into spine and plexus anatomy, delineates the clinical assessment of both pathologies, and highlights powerful diagnostic tools in the hopes of bolstering appropriate diagnosis and treatment. Lastly, this review will describe emerging treatment options for both pathologies in the preclinical and clinical realms, with a special emphasis on regenerative nerve therapies.

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“…11,12 Mild sensory deficits have been found in patients obturator transfer to the femoral nerve, but patients did not find this sensory loss to be limiting. 40 Deficits after branches of the tibial nerve are used as donor nerves include deficits in toe flexion, decreased calf circumference, or decreased ankle plantarflexion. 25 However, these deficits must be weighed against the potential benefits of a successful nerve transfer.…”

Section: Complicationsmentioning

confidence: 99%

Nerve Transfers in the Lower Extremity

Grisdela¹,

Ostergaard²,

Watkins³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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The utilization of nerve transfer procedures in the upper extremity following brachial plexus injury, trauma, spinal cord injury, tumors, infection, or other etiologies are well established. Nerve injuries in the lower extremity pose several additional challenges, including longer distance to target motor end plates, delayed presentation, and concomitant limb trauma. Nerve transfers in the lower extremity have the potential to provide functional (sensory or motor) recovery distally after direct surgical coaptation of a functional donor nerve to a non-functional recipient nerve. The ability to perform pure motor or sensory fascicular transfers allows for focused recovery while limiting donor morbidity. Indications for nerve transfers in the lower extremity are evolving, but transfers have been utilized for non-recovering peroneal, obturator, femoral, or tibial nerve palsies, to provide protective sensation to the plantar aspect of the foot as well as for painful neuropathies/neuromas. There is a paucity of orthopaedic literature on this topic and our review aims to highlight the current state of lower extremity nerve transfers as they relate to the practicing orthopaedist, including future directions in the field. Key Concepts• Nerve transfers have been well-established as a treatment option for nerve injuries of the upper extremity and brachial plexus, but their use in the lower extremities is less common.• Nerve transfers may be of particular interest in the lower extremity because of the ability to cover relatively long distances as well as avoid the zone of injury, especially in far proximal injuries.• Nerve transfers of the lower extremity have been used to address motor deficit of the peroneal, femoral, obturator, and tibial nerves, as well as tibial and sural nerve sensory loss.• There is currently a paucity of orthopaedic literature on lower extremity nerve transfers and further understanding is required to better utilize these techniques to manage lower extremity peripheral nerve injury.

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Different Surgical Reconstructions for Femoral Nerve Injury

Cited by 8 publications

References 5 publications

Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review

Differentiating Lumbar Spinal Etiology from Peripheral Plexopathies

Nerve Transfers in the Lower Extremity

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