Successful restoration of knee extension after transferring of the anterior branch of the obturator nerve: a case study.

Objective: Femoral nerve palsy occurs after trauma, surgical procedures and tumors and leads to loss of quadriceps functions, disability and decreased quality of life. The aim of this report was to describe a successful restoration of knee extension by transferring the anterior branch of the obturator nerve to selective branches of the femoral nerve at the thigh level.Methods: We describe a 27-year-old male who had quadriceps femoris muscle paralysis after surgical evacuation for retroperitoneal hematoma five months ago. Since proximal stump of femoral nerve was not accessible, we transferred anterior branch of obturator nerve to selective branches of femoral nerve for reconstruction of quadriceps femoris muscle.Results: After four months, he regained quadriceps muscle strength M3 and began to walk. He achieved full muscle strength (M5) nine months after surgery and was able to walk up-stairs easily 14 months after surgery and atrophy of the quadriceps was improved.Conclusion: The anterior branch of the obturator nerve is an available donor nerve with an excellent functional recovery for the reconstruction of knee extension when proximal stump of femoral nerve is not reachable or the repair needs a long graft.

Soleus nerve transfer to deep peroneal nerve for treatment of foot drop.

Different mechanisms including knee dislocation, replacement surgery, nerve tumor, lumbar disc herniation, sharp injury, and gunshot wound lead to foot drop. Several surgical techniques have been used for treatment of foot drop, however, they have had sub-optimal outcomes. Soleus branch of tibial nerve is a good donor for nerve transfer for treatment of foot drop. In this is retrospective study, we reviewed medical records of 6 consecutive patients with sustained foot drop following injury to lumbar root or peroneal nerve, who underwent transfer of the soleus branch of tibial nerve to deep peroneal nerve during 2014-2016. The mean age of the patients was 44.8 years and duration of injury to surgery and follow-up was 8.3 and 14.6 months, respectively. At the end of the follow-up, ankle dorsiflexion force was M4 in two patients (with traumatic peroneal nerve injury with M3 toe extension) and was M2 in one patient. There were three patients with lumbar degenerative disease. Of these patients, two showed M0 and one patient experienced M1 ankle dorsiflexion. We recommend that transfer of soleus nerve to deep peroneal nerve is used as an alternative technique for treatment of foot drop.