The anatomy of the lateral cutaneous nerve of the thigh--a possible donor nerve for facial nerve repair

Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and Its Passage beneath the Inguinal Ligament

BACKGROUND

Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve. According to the literature, the nerve travels beneath the inguinal ligament 1.3 to 5.1 cm medial to the anterior superior iliac spine. Compression at this site may cause pain and paresthesia. The aim of this study was to provide more accurate measurements to improve the diagnostic and surgical management of meralgia paraesthetica.

METHODS

The lateral femoral cutaneous nerve was dissected bilaterally in 50 Thiel-embalmed human cadavers. Measurements were performed with a standard caliper at the superior and inferior margins of the inguinal ligament. The distance from the inner lamina of the anterior superior iliac spine to the medial margin of the lateral femoral cutaneous nerve was measured. Data were collected and statistical analysis was performed with R.

RESULTS

Ninety-three lateral femoral cutaneous nerves of 50 cadavers were dissected. In 6 percent of cadavers, the lateral femoral cutaneous nerve could not be found. The mean distance from the inner lamina of the anterior superior iliac spine to the lateral femoral cutaneous nerve's medial border was 2.1 ± 1.3 cm (range, 0.2 to 6.4 cm; 95 percent CI, 1.8 to 2.4 cm) at the superior margin of the inguinal ligament and 1.9 ± 1.4 cm (range, 0.2 to 3.0 cm; 95 percent CI, 1.6 to 2.2 cm) at the inferior border of the inguinal ligament.

CONCLUSION

This anatomical study shows that the majority of the lateral femoral cutaneous nerve passes beneath the inguinal ligament in a very narrow area of 0.6 cm.

The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis

Purpose

Several variations in the anatomy and injury of the lateral femoral cutaneous nerve (LFCN) have been studied since 1885. The aim of our study was to analyze the available data on the LFCN and find a true prevalence to help in the planning and execution of surgical procedures in the area of the pelvis, namely inguinal hernia repair.

Methods

A search of the major medical databases was performed for LFCN anatomy. The anatomical data were collected and analyzed.

Results

Twenty-four studies (n = 1,720) were included. The most common pattern of the LFCN exiting the pelvis was medial to the Sartorius as a single branch. When it exited in this pattern, it did so on average 1.90 cm medial to the anterior superior iliac spine (ASIS).

Conclusions

The LFCN and its variations are important to consider especially during inguinal hernia repair, abdominoplasty, and iliac bone grafting. We suggest maintaining a distance of 3 cm or more from the ASIS when operating to prevent injury to the LFCN.

Electronic supplementary material

The online version of this article (doi:10.1007/s10029-016-1493-7) contains supplementary material, which is available to authorized users.

Injury to the lateral femoral cutaneous nerve during minimally invasive hip surgery: a cadaver study

INTRODUCTION

A smaller skin incision as part of minimally invasive surgery (MIS) for total hip arthroplasty (THA) is thought to reduce local tissue trauma. Preservation of cutaneous nerves may reduce postoperative pain and improve rehabilitation. The standard lateral approach (SLA) and two MIS approaches (anterolateral [ALA] and posterior [PA]) were compared to determine which incision preserved cutaneous nerves.

PATIENTS AND METHODS

Fifteen cadaveric hip specimens were dissected to establish the course of branches of the lateral femoral cutaneous nerve. The number of branches divided by each of the three incisions was recorded.

RESULTS

The MIS incisions resulted in significantly less nerve division compared with the SLA. The mean difference between the SLA and the ALA was 4.4 (P < 0.0001), and between the SLA and the PA was 1.4 (P = 0.0005). The ALA divided significantly fewer nerves compared with the PA (mean difference = 3; P = 0.0001).

DISCUSSION

There is little evidence of the benefit of one MIS approach over another in the literature. The ALA preserved significantly more cutaneous nerves in this study. These results need corroboration with clinical outcomes to determine their significance.

Meralgia paresthetica as the presenting feature of chronic appendicitis

Meralgia paresthetica is an entrapment syndrome of the lateral cutaneous nerve of the thigh manifesting as paresthesia, pain, numbness, or sensory loss in the distribution of the nerve. A variety of causes have been described; however, the etiology often remains unknown. On the basis of our investigations with a patient with meralgia paresthetica, we determined that an inflammatory rather than mechanical effect on the lateral cutaneous nerve of the thigh may account for the pathogenesis; however, a certain conclusion about this issue can not be made.