Restoration of Leg Function with a Femoral Branch Nerve Transfer to the Anterior Obturator Nerve after an Iatrogenic Injury

Abstract

Iatrogenic injury of the obturator nerve represents an uncommon yet clinically relevant complication after pelvic surgery. If not recognized intraoperatively, conservative management remains the primary therapeutic approach. Surgical intervention may be indicated in cases with persistent symptoms. Although nerve transfer procedures are frequently used in nerve lesions of the upper extremity, they have rarely been employed for nerve injuries in the lower extremities.

We present the case of a 61-year-old patient who presented to our outpatient clinic 4 months after bilateral endoscopic obturator hernia surgery with significant weakness in right leg adduction, without any improvement through physiotherapy. After failed conservative therapy, he underwent an end-to-side transfer of a femoral branch to the obturator nerve to restore adduction of the thigh. Nine months after surgery, the patient was pain-free, showed good function of thigh adduction, was able to fully work as a metal worker, and could pursue his leisure sport activities without impairment. Electroneuromyography demonstrated that the right adductor magnus muscle was primarily innervated by the femoral nerve. No donor site morbidity was observed.

Nerve transfer may therefore represent a valuable treatment option for patients with obturator nerve injury who do not show sufficient improvement with conservative management.