Transferring of femoral nerve motor branches for high-level sciatic nerve injury: a cadaver feasibility study
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Sciatic nerve injuries cause significant disability. We propose here a novel reconstructive procedure of transferring the motor branches of the femoral nerve as donor nerves to reconstruct both the peroneal and tibial nerve function as a novel approach to treat high sciatic nerve injury.
The autopsies of donor nerves (vastus lateralis nerve branch (VLN), vastus medialis nerve branch (VMN), saphenous nerve (SAN)) and respective recipient nerves (deep peroneal nerve branch (DPN), medial gastrocnemius nerve branch (MGN), sural nerve (SN)) were conducted in six fresh-frozen lower limbs. The distance between the origin or bifurcation points of the nerves to the head of fibula and the diameter of the end at the coaptation site were measured. The feasibility of tensionless direct suturing or grafting between the donor nerves and the recipient was evaluated. Finally, the nerve end at the coaptation site was harvested for observation with toluidine blue staining and nerve fiber count.
The mean diameter of the VMN, VLN, MGN, DPN, SAN, and SN nerves were 1.5 ± 0.1, 1.4 ± 0.1, 1.3 ± 0.1, 2.3 ± 0.1, 2.1 ± 0.3, and 1.3 ± 0.2 mm, respectively. Histological observation showed that the abovementioned six nerve bundles had a respective nerve fiber number of 392 ± 27, 205 ± 520, 219 ± 67, 394 ± 50, 308 ± 77, and 335 ± 49. A total of 5/6 specimens needed grafting for a length ranging from 5 to 15 cm to bridge the VMN–MGN, 6/6 needed a graft length of 10–20 cm for VLN–DPN bridging, and 2/6 needed a graft length of 0–4 cm for SAN–SN bridging.
The study demonstrated the feasibility of the transferring femoral nerve branches to sciatic nerve branches to restore the function for sciatic injury.
KeywordsNerve transfer Sciatic nerve injury Femoral nerve Anatomic feasibility
vastus medialis nerve branch
vastus lateralis nerve branch
medial gastrocnemius nerve branch
lateral gastrocnemius nerve branch
deep peroneal nerve branch
superficial peroneal nerve branch
medial sural nerve
lateral sural nerve
common peroneal nerve
medical research council
This study was funded by the National Natural Scientific Foundation of China (grant number 81572146), the Program of Outstanding Medical Talent of Shanghai Municipal Health Bureau (grant number 2017BR034), the Shuguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission (grant number 15SG34), and the Project of Research Doctor of Changzheng Hospital (grant number 201712).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human specimens were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with human participants performed by any of the authors.
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