Isolated permanent femoral nerve palsy is a rare pathology that causes significant disability. 1,2 A true unilateral complete proximal femoral nerve palsy will result in the wasting of the quadriceps, iliacus and sartorius, variable wasting of pectineus and a sensory deficit in the anteromedial thigh and medial aspect of the leg. This causes a well-described gait disturbance and renders the patient unable to ambulate independently without significant difficulty or the use of gait aids. 3 The aetiology of isolated permanent femoral nerve palsy is varied. The vast majority of reported permanent unilateral femoral nerve palsy cases in the modern era are from unintended iatrogenic injury, or a planned necessity for oncologic clearance. 1 Other causes include iliopsoas haematoma, iliopectineal bursitis, trauma and diffuse large B-cell lymphoma. 2,4 Regardless of aetiology, this is a complex reconstructive problem with poor intrinsic idiopathic regenerative capabilities. There are few documented cases 4-6 of various pattern obturator nerve transfers for femoral nerve deficits with good functional outcomes.Here we present a novel technique with a clinical case including long-term follow-up, for the restoration of quadriceps function with no discernible donor deficit.Mr JV is a piano mover who was involved in a high-speed motor vehicle accident (MVA) at age 49. He sustained major pelvic fractures managed non-operatively, in addition to facial, chest and abdominal injuries. He originally had a diffuse critical illness polyneuropathy, which resolved to reveal an underlying isolated right-sided femoral nerve palsy. It was at this point, 4 months postinjury, that he was referred to the senior author (SF). The right quadriceps were completely wasted with 0/5 power and absent sensation consistent with complete femoral nerve palsy. Ipsilateral hamstrings, adductors and both anterior and posterior leg compartments were at least 4/5 power. There were multiple scars consistent with the original trauma but no evidence of surgery in the region of the proximal femoral nerve. Femoral nerve surgery was performed 5 months after the original trauma.There is little data in the literature regarding expected resolution ranges for critical illness polyneuropathy resolution, if any can occur from a few weeks after onset to months. 7 In this case, the indication for surgery at this time was the persisting isolated femoral palsy despite resolution of weakness in the other muscle groups.Intraoperatively, the right femoral nerve had a flat and empty appearance at the level of the inguinal ligament. There was no proximal stump available for reconstruction. These surgical findings were in keeping with the pre-operative hypothesis that the femoral nerve palsy was in addition to the resolved critical illness polyneuropathy.The following nerve transfers were performed (Fig. 1): 1. Nerve to gracilis transfer to a common intermediate quadriceps nerve. 2. Nerve to adductor longus transfer to definitive nerve to vastus medialis. Both transfers had good si...

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