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. 2018:51:58-61.
doi: 10.1016/j.ijscr.2018.08.004. Epub 2018 Aug 9.

Transfer of the anterior branch of the obturator nerve for femoral nerve reconstruction and preservation of motor function: A case report

Marco Rastrelli  1 , Ilaria Tocco-Tussardi  2 , Saveria Tropea  1 , Carlo Riccardo Rossi  1 , Sandro Rizzato  3 , Vincenzo Vindigni  3
Affiliations

Transfer of the anterior branch of the obturator nerve for femoral nerve reconstruction and preservation of motor function: A case report

Marco Rastrelli et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Femoral nerve lesions are uncommon but severely disrupting at the functional level, because of the inability to walk, run, and passing from sitting to standing position. Reconstruction via local nerve transfer (neurotization) is a relatively new yet promising procedure.

Presentation of case: We describe a case of successful restoration of rectus femoris' function after a malignant process by transfer of the anterior branch of the obturator nerve at the thigh level. At present, only few similar reports are present in the literature. Nerve gap after surgery was considerable (10 cm) and nerve grafting could have been unsatisfactory in terms of reinnervation. Therefore, reconstruction was managed with nerve isolation and transfer to the rectus femoris motor branch. The functional result was satisfactory at 1-year follow up with margins for further improvement.

Discussion: This case reported favorable outcomes of neurotization of the anterior branch of the obturator nerve for femoral nerve lesion. Reports of success with this procedure are still limited, but the promising results in terms of functional recovery suggest it should be offered to patients as a viable therapeutic option.

Conclusion: Advantages of neurotization compared to grafts are several, including: limiting suturing sites and scarring; shortening the recovery time by decreasing the required regeneration distance; and allowing for faster muscle reinnervation. The choice to transfer the anterior branch of the obturator nerve specifically allows to preserve part of the adductor functionality in the thigh without affecting the stability of the knee joint.

Keywords: Anterior branch of the obturator nerve; Femoral nerve; Gracilis; Nerve transfer; Neurotization.

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Figures

Fig. 1
Fig. 1
Intra-operative photographs. (Left) Operative exposure. (Right) After transposition of the anterior branch of the obturator nerve to femoral branches to rectus femoris, the soft tissue defect is covered with a rotation of muscular flap.
Fig. 2
Fig. 2
Post-operative photographs 1 year after surgery.
See this image and copyright information in PMC

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