Anatomical study on the repair of femoral nerve injury with anterior branch of obturator nerve_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jun , LIN Yaofa , ZONG Haiyang , XIE Zheng ,  LIN Haodong , HOU Chunlin

Department of Bone Trauma and Reconstructive Surgery, Shanghai Changzheng Hospital, Shanghai, 200003, P.R.China;

Corresponding author：

LIN Haodong, Email: haodonglin@hotmail.com

Keywords：

Obturator nerve; femoral nerve; nerve transposition; nerve injury

DOI：

10.7507/1002-1892.201705046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility of the anastomosis of the anterior branch of obturator nerve and the muscular branch of femoral nerve. Methods Five fresh frozen cadavers, including 3 males and 2 females, were included. Both of the obturator nerve, femoral nerve and their branches were dissected, then their routes and anatomical positions were observed. The diameter and the number of myelinated nerve fiber of the anterior branch of obturator nerve and femoral nerve muscular branches were measured, as well as the overlap distance between them. Results The diameter of myelinated nerve fiber of the anterior branch of obturator nerve was (3.80±1.22) mm; the number of myelinated nerve fiber was 11 358±800. The diameters of the rectus femoris branch and the medial femoral branch were (1.60±0.54) mm and (2.20±0.66) mm, respectively; the number of myelinated nerve fiber were 4 961±655 and 6 666±466. Both the diameter and number of myelinated nerve fiber were close to the anterior branch of obturator nerve. The anterior branch of obturator nerve could be directly anastomosed with each nerve branch of femoral nerve in nontension, and the overlap distance was about 30 mm. Conclusion It is feasible to repair the femoral nerve by transposed the anterior branch of obturator nerve and anastomosed with the femoral nerve muscular branches. And the rectus femoris branch and the medial femoral branch should be taken as the recipient nerve.

Citation： ZHOU Jun, LIN Yaofa, ZONG Haiyang, XIE Zheng, LIN Haodong, HOU Chunlin. Anatomical study on the repair of femoral nerve injury with anterior branch of obturator nerve. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1367-1370. doi: 10.7507/1002-1892.201705046 Copy

1.	Kim DH, Murovic JA, Tiel RL, et al. Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases. J Neurosurg, 2004, 100(6): 989-996.
2.	Campbell AA, Eckhauser FE, Belzberg A, et al. Obturator nerve transfer as an option for femoral nerve repair: case report. Neurosurgery, 2010, 66(6 Suppl Operative): 375.
3.	Inaba N, Sato K, Suzuki T, et al. Partial obturator nerve transfer for femoral nerve injury: a case report. J Orthop Sci, 2016. [Epub ahead of print].
4.	Kim DH, Kline DG. Surgical outcome for intra- and extrapelvic femoral nerve lesions. J Neurosurg, 1995, 83(5): 783-790.
5.	Whitlock EL, Tuffaha SH, Luciano JP, et al. Processed allografts and type Ⅰ collagen conduits for repair of peripheral nerve gaps. Muscle Nerve, 2009, 39(6): 787-799.
6.	Tsuchihara T, Nemoto K, Arino H, et al. Sural nerve grafting for long defects of the femoral nerve after resection of a retroperitoneal tumour. J Bone Joint Surg (Br), 2008, 90(8): 1097-1100.
7.	Moore AM, Novak CB. Advances in nerve transfer surgery. J Hand Ther, 2014, 27 (2): 96-105.
8.	Thomas HT. Nerve Transfers. Clin Plast Surg, 2014, (41): 552-559.
9.	Ray WZ, Chang J, Hawasli A, et al. Motor nerve transfers: A comprehensive review. Neurosurgery, 2016, 78(1): 1-25.
10.	张永, 王国亚, 杨胜波. 股神经和闭孔神经肌支转位的解剖学测量和神经纤维定量. 中国临床解剖学杂志, 2014, 32(5): 544-547.
11.	尹刚, 侯春林, 林浩东, 等. 闭孔神经或生殖股神经移位修复腰骶丛根性撕脱伤的应用解剖学研究. 中国临床解剖学杂志, 2012, 30(5): 487-490.
12.	王树锋, 薛云浩, 刘佳勇, 等. 闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用. 中华骨科杂志, 2009, 29(5): 387-392.
13.	Iorio ML, Felder JM 3rd, Ducic I. Anterior Branch of the Obturator Nerve: A Novel Motor Autograft for Complex Peripheral Nerve Reconstruction. Ann Plast Surg, 2011, 67(3): 260-262.
14.	Tung TH, Chao A, Moore AM. Obturator nerve transfer for femoral nerve reconstruction: anatomic study and clinical application. Plast Reconstr Surg, 2012, 130(5): 1066-1074.
15.	姜宗圆, 王涛, 徐祝军, 等. 不同术式神经移位至桡神经疗效观察. 中华创伤骨科杂志, 2015, 21(8): 567-570.
16.	Aldea PA, Shaw WW. Management of acute lower extremity nerve injuries. Foot Ankle, 1986, 7(2): 82-94.

1. Kim DH, Murovic JA, Tiel RL, et al. Intrapelvic and thigh-level femoral nerve lesions: management and outcomes in 119 surgically treated cases. J Neurosurg, 2004, 100(6): 989-996.
2. Campbell AA, Eckhauser FE, Belzberg A, et al. Obturator nerve transfer as an option for femoral nerve repair: case report. Neurosurgery, 2010, 66(6 Suppl Operative): 375.
3. Inaba N, Sato K, Suzuki T, et al. Partial obturator nerve transfer for femoral nerve injury: a case report. J Orthop Sci, 2016. [Epub ahead of print].
4. Kim DH, Kline DG. Surgical outcome for intra- and extrapelvic femoral nerve lesions. J Neurosurg, 1995, 83(5): 783-790.
5. Whitlock EL, Tuffaha SH, Luciano JP, et al. Processed allografts and type Ⅰ collagen conduits for repair of peripheral nerve gaps. Muscle Nerve, 2009, 39(6): 787-799.
6. Tsuchihara T, Nemoto K, Arino H, et al. Sural nerve grafting for long defects of the femoral nerve after resection of a retroperitoneal tumour. J Bone Joint Surg (Br), 2008, 90(8): 1097-1100.
7. Moore AM, Novak CB. Advances in nerve transfer surgery. J Hand Ther, 2014, 27 (2): 96-105.
8. Thomas HT. Nerve Transfers. Clin Plast Surg, 2014, (41): 552-559.
9. Ray WZ, Chang J, Hawasli A, et al. Motor nerve transfers: A comprehensive review. Neurosurgery, 2016, 78(1): 1-25.
10. 张永, 王国亚, 杨胜波. 股神经和闭孔神经肌支转位的解剖学测量和神经纤维定量. 中国临床解剖学杂志, 2014, 32(5): 544-547.
11. 尹刚, 侯春林, 林浩东, 等. 闭孔神经或生殖股神经移位修复腰骶丛根性撕脱伤的应用解剖学研究. 中国临床解剖学杂志, 2012, 30(5): 487-490.
12. 王树锋, 薛云浩, 刘佳勇, 等. 闭孔神经移位修复腰骶丛神经根撕脱伤的解剖学观察及临床应用. 中华骨科杂志, 2009, 29(5): 387-392.
13. Iorio ML, Felder JM 3rd, Ducic I. Anterior Branch of the Obturator Nerve: A Novel Motor Autograft for Complex Peripheral Nerve Reconstruction. Ann Plast Surg, 2011, 67(3): 260-262.
14. Tung TH, Chao A, Moore AM. Obturator nerve transfer for femoral nerve reconstruction: anatomic study and clinical application. Plast Reconstr Surg, 2012, 130(5): 1066-1074.
15. 姜宗圆, 王涛, 徐祝军, 等. 不同术式神经移位至桡神经疗效观察. 中华创伤骨科杂志, 2015, 21(8): 567-570.
16. Aldea PA, Shaw WW. Management of acute lower extremity nerve injuries. Foot Ankle, 1986, 7(2): 82-94.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical study on the repair of femoral nerve injury with anterior branch of obturator nerve

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