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Cadaveric Study of the Femoral Nerve Sensory Branches: An Anatomical Guide for Anterior Thigh Nerve Reconstruction
Anna M. Vaeth
*1, Tanya Maistry
2, Nancy Qin
1, Makayla Kochheiser
1, Lucy Wei
1, Paul A. Asadourian
1, Estomih P. Mtui
2, David Otterburn
11Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY; 2Radiology/Anatomy Division, Weill Cornell Medicine, New York, NY
Background: Majority of nerve reconstruction techniques are performed on the sciatic nerve in above-the-knee amputees. However, sensory branches in the anterior thigh are often overlooked and may contribute to postoperative pain. This study aims to provide an anatomical guide for performing targeted muscle reinnervation (TMR) in the anterior thigh to improve pain in transfemoral amputees.
Methods: This observational study was conducted on formalin-fixed, well-embalmed cadaveric lower limbs. The femoral nerve was identified and dissected to isolate its anterior and posterior divisions. The saphenous nerve is the terminal branch of the posterior division of the femoral nerve entering the adductor canal. Linear measurements were taken from the midpoint of the inguinal ligament (IL) in the direction of the medial femoral condyle.
Results: Twelve limbs were dissected. The median distance from the IL to the saphenous branch point was 19cm (IQR: 19.1-25.5cm). The nerve to vastus medialis (VM) was the closest motor branch to the saphenous nerve in 83% of limbs, originating at a median distance of 17.8 cm (IQR: 15.9-21.5cm). From the posterior division of the femoral nerves, 60% gave two motor branches to VM, 30% gave three, and 10% gave four. In two limbs we observed no VM branches from the posterior division and found the closest motor branches were to vastus intermedius (9cm) and to sartorius (18cm). Proximally, branches to vastus intermedius were found in 7 limbs, originating at a median distance of 6.5cm. The nerve to rectus femoris branched from the posterior division of the femoral nerve in 3 limbs with a median distance of 4.5cm. The nerve to sartorius typically branched before the IL and entered the muscle laterally at a median distance of 5 cm (IQR: 4-7.8cm).
Conclusions: Surgeons performing TMR of the femoral/saphenous nerve should explore the medial thigh approximately 16-26cm distal to the inguinal crease to reliably identify VM targets. If more proximal, surgeons should target nerves to sartorius, rectus femoris, and vastus intermedius muscles.
Figure 1: Diagram showing the measurements from midpoint of the IL to the medial femoral condyle (A) and image showing the dissected saphenous nerve and motor branches to VM (B). The saphenous nerve branch and motor branches to VM were found 16-26cm from the IL. IL = Inguinal ligament; PT = Pubic tubercle; ASIS = Anterior superior iliac spine; VM = vastus medialis
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