Repair of the femoral nerve by two motor branches of the obturator nerve: A case report

Dubois, Elodie; Popescu, Ion-Andrei; Nachef, Nadine; Teboul, F.; Goubier, J.-N.

doi:10.1002/micr.30527

Cited by 12 publications

(12 citation statements)

References 14 publications

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“… 5 In cases of quadricep deficiency, obturator to femoral nerve transfers have been described with favorable outcomes. 6 , 7 The obturator nerve plays an important role in hip stabilization and, thus, fires synergistically with the quadriceps during synergy A (Table 2 ; Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

Magrath

Qiu

Hanwright

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Functional lower extremity reconstruction primarily aims to restore independent ambulation. We sought to define the synergies recruited during a walking gait to inform donor selection for various motor deficits. With these findings, we discuss the functional neuromuscular components of independent gait with the goal of informing lower extremity reconstruction. Methods: A systematic review was performed using MEDLINE for articles published between January 2000 and December 2020. Search terms included (1) “motor module(s),” “synergy,” “motor pattern,” or “motor primitive” and (2) “gait,” “walking,” “ambulation,” or “locomotion.” Abstracts/full texts were reviewed by two independent reviewers. Results: A total of 38 studies were selected. The average reported number of synergies and variance accounted for was 4.5 ± 0.9 and 88.6% ± 7.7%, respectively. Four motor modules were conserved across nearly all studies. Conclusions: Walking can be reduced to the sequential activation of four motor modules. Activities during the stance phase are critical for both standing stability and forward progression and should be prioritized for reconstruction with the goal of preserving efficient gait. Muscles recruited during swing, except those used for ankle dorsiflexion, are less prone to injury and benefit from greater redundancy, less often necessitating reconstruction. With the emphasis on stability during stance, several synergistic or sometimes even antagonistic tendons can be used to replace their counterparts and restore efficient, independent ambulation. With a finite supply of donor tissues, and in the absence of well-defined clinical outcomes data, this research allows us to effectively prioritize reconstructive goals and maximize patient outcomes.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

Magrath

Qiu

Hanwright

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…For example, although previous anatomical and clinical studies have verified the feasibility that the anterior obturator nerve could reach the RF and VM branch with tension-free below the inguinal ligament as well as preserve partial adductor function of the obturator nerve. 12 Unfortunately, all the patients undergoing anterior obturator nerve transfer still had difficulty in running, rising and squatting, walking up and down stairs 2 years postoperatively, 26 which might be due to insufficient donor axons and underpowered of the nerve fibers. 27,28 In our present study, we measured the nerve overlap distance between the gracilis branch and the RF branch, the AL branch and the VM branch, as well as the AM branch and the VI branch, the repair of femoral nerve injuries by transferring the obturator nerve branches appeared to be without tension.…”

Section: Discussionmentioning

confidence: 99%

Selective Repair of Motor Branches in the Femoral Nerve by Transferring the Motor Branches of Obturator Nerve

et al. 2023

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Background Anterior branch of the obturator nerve transfer has been proven as an effective method for femoral nerve injuries, but the patient still has difficulty in rising and squatting, up and downstairs. Here, we presented a novel neurotization procedure of selectively repairing 3 motor branches of the femoral nerve by transferring motor branches of the obturator nerve in the thigh level and assessing its anatomical feasibility. Methods Eight adult cadavers (16 thighs) were dissected. The nerve overlap distance between the gracilis branch and the rectus femoris (RF) branch, the adductor longus (AL) branch and the vastus medialis (VM) branch, as well as the adductor magnus (AM) branch and the vastus intermedius (VI) branch were measured. Also, the axon counts of the donor and recipient nerve were evaluated by histological evaluation. Results In all specimens, nerve overlap of at least 2.1 cm was observed in all 16 dissected thighs between the donor and recipient nerve branches, and the repair appeared to be without tension. There is no significant difference in the axon counts between gracilis branch (598 ± 83) and the RF branch (709 ± 151). The axon counts of the AL branch (601 ± 93) was about half of axon counts of the VM branch (1423 ± 189), and the axon counts of AM branch (761 ± 110) was also about half of the VI branch (1649 ± 281). Conclusions This novel technique of the combined nerve transfers below the inguinal ligament, specifically the gracilis branch to the RF branch, the AL branch to the VM branch, and the AM branch to the VI branch, is anatomically feasible. It provides a promising alternative in the repair of femoral nerve injuries and an anatomical basis for the clinical application of motor branches of the obturator nerve transfer to repair the motor portion of the injured femoral nerve.

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“…A more distal obturator nerve transfer can be an attractive option as it avoids dissection in a potentially scarred and previously traumatized pelvis, allows only motor nerves to be transferred, and preserves some innervation to the hip adductors. Transfer of the anterior obturator branch to the distal femoral nerve or select motor branches of the femoral nerve has been described [18,21,[26][27][28] . Good return of function has also been reported with transferring branches of the obturator nerve to the gracilis and adductor longus to the quadriceps branch of the femoral nerve [29] .…”

Section: Obturator Donormentioning

confidence: 99%

Lower extremity nerve transfers: an under-appreciated reconstructive approach

Yu¹,

Crowe²,

Lipira³

et al. 2023

Plast Aesthet Res

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Lower extremity peripheral nerve injuries can be highly morbid to patients and challenging problems for reconstructive surgeons to manage. Nerve transfers have recently emerged as a promising technique in the treatment of these injuries. The nerve-transfer paradigm is predicated on the use of an expendable, unaffected nerve as a donor of axons to restore motor or sensory function in the target end organ. Distal transfers close to the end motor or sensory organ may allow for earlier and more robust reinnervation compared to more proximal primary repair or grafting. However, as clinical data on outcomes and rigorous comparative studies remain scarce, reconstructive surgeons must rely on principle-based treatment including a detailed understanding of lower extremity neuromuscular anatomy, gait mechanics, and nerve physiology to develop an appropriate treatment plan for each patient with the goal of functional limb restoration and independent gait. In this article, we review current concepts of lower extremity nerve transfers, including techniques and outcomes according to indication.

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Repair of the femoral nerve by two motor branches of the obturator nerve: A case report

Cited by 12 publications

References 14 publications

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

A Systematic Review of Muscle Synergies during a Walking Gait to Define Optimal Donor-Recipient Pairings for Lower Extremity Functional Reconstruction

Selective Repair of Motor Branches in the Femoral Nerve by Transferring the Motor Branches of Obturator Nerve

Lower extremity nerve transfers: an under-appreciated reconstructive approach

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