Anatomical feasibility study on direct coaptation of the lateral femoral cutaneous nerve to the tensor fasciae latae muscle nerve as a treatment for meralgia paresthetica by targeted muscle reinnervation.

[INTRODUCTION] Surgical treatment of meralgia paresthetica (MP) is difficult, with lateral femoral cutaneous nerve (LFCN) neurectomy appearing to give the best results at the cost of a potentially painful post-resection neuroma. The targeted muscle reinnervation (TMR) surgical technique allows the axons of a damaged sensory nerve to regrow into the motor end plates of a muscle, thus preventing the formation of a neuroma. This study describes the use of the terminal branch of the superior gluteal nerve for the tensor fasciae latae muscle (bSGN/TFL) as a recipient for LFCN regrowth for the treatment of MP by TMR.

[METHODS] 20 dissections were performed on 10 fresh frozen donated bodies (mean age: 81.9, sex ratio 0.5). Using a single approach, the bSGN/TFL was accessed at its entry into the TFL muscle and dissected retrogradely as far as the space between the TFL muscle and the gluteus medius muscle allowed, then sectioned. The bSGN/TFL was then coapted with the LFCN stump above the inguinal ligament.

[MAIN RESULTS] In all cases, coaptation was achieved. The maximum length of bSGN/TFL that could be harvested via a single incision was 7.1 (5-11) cm. The average length of bSGN/TFL required to achieve coaptation was 5.7 (4.3-9) cm. Intraneural dissection of one of the SGN branches to the gluteus muscles was necessary in 16 cases.

[DISCUSSION/CONCLUSION] TMR appears to be the only technique capable of both treating neuropathic pain and hyperalgesia secondary to MP. This technique could be used as a first-line treatment and/or in cases where neurectomies have failed to treat MP.