Femoral branch to obturator nerve transfer for restoration of thigh adduction following iatrogenic injury

Case report

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Obturator nerve injury is a rare complication of pelvic surgery. A variety of management strategies have been reported, with conservative measures being the preferred treatment in most cases. While nerve transfer has become more commonly used for restoring brachial plexus injuries, it has rarely been applied to the lower extremities. To the authors' knowledge, this is the first report of an obturator nerve neurotization. A patient presented 7 months after an iatrogenic right obturator nerve palsy due to pelvic surgery for gynecological malignancy. She underwent a femoral branch to obturator nerve transfer to restore right thigh adduction. Ten months after the neurotization procedure, there was electromyographic evidence of almost complete obturator nerve reinnervation. At 1 year postoperatively, the patient had regained full muscle strength on thigh adduction and a normal gait. Nerve transfer could therefore be a good option in patients with obturator nerve injury whose symptoms fail to respond to conservative medical therapy.

Abbreviation used in this paper: EMG = electromyography.

Article Information

Address correspondence to: Ziv Williams, M.D., Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WAC 745K, Boston, Massachusetts 02114. email: zwilliams@partners.org.

Please include this information when citing this paper: published online February 25, 2011; DOI: 10.3171/2011.1.JNS101239.

© AANS, except where prohibited by US copyright law.

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    Schematic depicting the neurotization procedure. Upper: Several branches of the femoral nerve as well as the obturator nerve are shown. A medial branch of the femoral nerve was cut distally, and the obturator nerve was cut proximally close to the obturator foramen. Lower: The distal end of the cut femoral nerve was coapted to the proximal cut end of the obturator nerve. The dashed straight line represents the inguinal ligament, and the dashed ellipse represents the obturator foramen.

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