PubMed · 3199345
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J F Bonneville, M Runge. 1988. [Chemonucleolysis].. https://pubmed.ncbi.nlm.nih.gov/3199345/
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The arrangement of the nerve bundles at the branching point of the femoral nerve (F), the interrelations of the branches each other and toward other nerves in the anterior region of the thigh, and the patterns and the anatomical features of both the running courses and the distributions of the branches were macroscopically studied, whereby some special findings were observed and the following results were obtained: 1) The periphery of the femoral nerve was fundamentally divided into superficial-deeply arranged three-layered divisions. Including the femoral branch of the genitofemoral nerve (Rf) and the femoral lateral cutaneous nerve (Cfl), the nerve branches at the anterior region of the thigh were totally divided into five-layered divisions. 2) The cutaneous branches of each division including Rf or Cfl could be classified in three groups: the medial cutaneous branches (m), the anterior cutaneous branches (a), and the lateral cutaneous branches (l). Based on the above results, the branches could be described systematically. Parallelly, several accessory bundles of F penetrating the psoas major muscle were observed, and two types of accessory femoral nerves (F') could be distinguished: One was higher on the segmentation and mainly flew into the 1st division of F. While the other distributed only to the medial region of the thigh. To clarify the segmental or stratifical natures of the branches of each division, F', and the interrelations among them, analyses of the nerve fibers were undertaken under the operational microscope. Consequently, the segmental differences between the divisions were distinct, and the medial branches or F'm obviously contained ventral components. Thus, when a component originated from the higher segments, it distributed to the proximal region generally taking a superficial course; when it originated from the lower ones, it distributed to the distal region of the thigh forming the deeper division; when it belonged to the ventral stratum, it distributed to the medial region; and when it belonged to the dorsal stratum, it distributed to the lateral region. On the occasion of the fiber analysis, it was found that each root of the lumbar nerve was generally divided into two or three subsegmentally-arranged subroots that divided themselves into some fasciculi arranged micro-segmentally. A minute analysis of the segmentations of the nerves became possible because of the above characteristics.
Postoperative femoral neuropathy is more common than it is generally appreciated. It can occur by a number of different mechanisms after a wide variety of operations as a result of either direct or indirect injury. Most instances occur after abdominopelvic operations and are associated with the placement of self-retaining retractors. A large body of evidence suggests that, in these patients, nerve compression by the lateral blades of the retractor is the cause. There is, however, evidence that the intrapelvic portion of the nerve is particularly susceptible to ischemia. Usually, there is a mild sensorimotor disturbance and the diagnosis is easily made by accurate physical examination during the early postoperative period. A diminished or absent knee jerk is the most reliable clinical sign. Recovery is the rule; it occurs usually from a few weeks to months. During this time, physiotherapy may be beneficial. Occasionally the lesion may be severe or prolonged, or both. In these instances, EMG studies are justified, not only to allay the fears of patients and physicians, but to evaluate the progress of the lesion over time. With the exception of certain unusual instances, this potentially debilitating postoperative complication can be avoided by careful placement of self-retaining retractors.