Femoral to sciatic nerve transfer: A cadaver study.

Background: Proximal sciatic nerve injuries are a challenge to treat due to the limited options for donor nerves and the long distance needed for regeneration. Methods: In our cadaveric study using five human cadavers, we aimed to evaluate the feasibility of transferring the tibial and common peroneal components of the sciatic nerve to the femoral nerve motor branches of the vastus medialis (VM) and vastus lateralis without the need for interposition nerve graft. The femoral nerve branches of the VM and lateralis were exposed anteriorly. The sciatic nerve was exposed posteriorly and passed through a narrow window within the adductor magnus and medial to the femur. The sciatic nerve was then separated into its tibial and peroneal components, which were then coapted to the VM and lateralis motor branches of the femoral nerve. Results: Using the entire tibial and peroneal components of the sciatic nerve, we were able to gain more length and directly coapt the femoral nerve branches without utilizing interposition grafts. The disadvantage of this technique is suturing to a mixed nerve with motor and sensory components, which could compromise functional outcomes. Further studies are needed to determine how the procedure will impact a patient's gait cycle. Conclusion: Clinical application is needed to determine preliminary outcomes before widespread utilization of this technique.