title: Obturator Nerve Transfer to the Branch of the Tibial Nerve Innervating the Gastrocnemius Muscle for the Treatment of Sacral Plexus Nerve Injury.
abstract: BACKGROUND
  Lower-limb function is severely impaired after sacral plexus nerve injury. Nerve transfer is a useful reconstructive technique for proximal nerve injuries.
  
  
  OBJECTIVE
  To investigate the clinical effectiveness and safety of transferring the ipsilateral obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle to recover knee and ankle flexion.
  
  
  METHODS
  From 2007 to 2011, 5 patients with sacral plexus nerve injury underwent ipsilateral obturator nerve transfer as part of a strategy for surgical reconstruction of their plexuses. The mean patient age was 31.4 years (range, 19-45 years), and the mean interval from injury to surgery was 5.8 months (range, 3-8 months). The anterior branch of the obturator nerve was coapted to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle by autogenous nerve grafting.
  
  
  RESULTS
  Patient follow-up ranged from 24 to 38 months. There were no complications related to the surgery. Three patients recovered to Medical Research Council grade 3 or better in the medial head of the gastrocnemius muscle. Thigh adduction function was not affected in any patient.
  
  
  CONCLUSIONS
  Knee and ankle flexion can be achieved by transferring the anterior branch of the obturator nerve to the branch of the tibial nerve innervating the medial head of the gastrocnemius muscle, which is useful for balance. This procedure can be used as a new method for treating sacral plexus nerve injury.
  
  
  BACKGROUND
  MRC, Medical Research Council.
authors.affiliation: Department of Orthopedic Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Yin
authors.forename: Huihao
authors.initials: H
authors.lastname: Chen
authors.forename: Chunlin
authors.initials: C
authors.lastname: Hou
authors.forename: Jianru
authors.initials: J
authors.lastname: Xiao
authors.forename: Haodong
authors.initials: H
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D008160:Lumbosacral Plexus / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D016067:Nerve Transfer / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009776:Obturator Nerve / Q000637:transplantation*; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D013979:Tibial Nerve / Q000601:surgery*; D055815:Young Adult