[Femoral nerve repair with autografts for proximal retroperitoneal damage (case report and literature review)]. / Autoplastika bedrennogo nerva pri ego proksimal'nom zabryushinnom povrezhdenii (klinicheskoe nablyudenie i obzor literatury).

ABSTRACT

Femoral nerve damage, especially in proximal retroperitoneal space, is rare. Therefore, surgical strategy is still unclear for these patients. Various specialists discuss repair with autografts or neurotization by the obturator nerve or its muscular branch. OBJECTIVE: To demonstrate the diagnostic algorithm for proximal femoral nerve injury and favorable outcomes after repair with long autografts. MATERIAL AND METHODS: We assessed movements and sensitivity using a five-point scale, as well as ultrasound, magnetic resonance imaging and electroneuromyography data in a patient with extended iatrogenic femoral nerve damage before and after repair with long autografts (10.5 cm). RESULTS AND DISCUSSION: The patient had complete femoral nerve interruption in proximal retroperitoneal space with 10-cm defect that required repair with five autografts from two sural nerves. Postoperative ultrasound and magnetic resonance imaging revealed signs of graft survival and no neuroma within the nerve suture lines. The first signs of motor recovery occurred after 10 months. After 14 months, strength of quadriceps femoris muscle comprised 4 points, and electroneuromyography confirmed re-innervation. CONCLUSION: Femoral nerve repair with autografts for complete proximal anatomical interruption can provide sufficient restoration of movements and sensitivity. Therefore, this surgical option should be preferred instead of neurotization. Ultrasound, MRI and ENMG are valuable to clarify the diagnosis and state of the autografts.