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1. Cadaveric Study of Variations in the Course of Lateral
Femoral Cutaneous Nerve: Insight to Prevent Injury
Dr. LINDA E G
POSTGRADUATE ,ANATOMY
KoIMS
MODERATOR – Dr. SHASHANKA

3. Lateral femoral cutaneous nerve is a branch of lumbar plexus.
Conveys fibers from dorsal branches of ventral rami of L2 &L3 spinal nerves
After emerging from the lateral border of psoas major, the nerve passes across the iliac
fossa beneath the fascia iliaca.
Passes inferomedially to the ASIS, then behind the inguinal ligament or through the
substance of inguinal ligament
In thigh it divides into 2 branches : Anterior and Posterior

4. ABOUT THE JOURNAL
Journal Name : Medeniyet medical journal
Journal feature: Index Medicus, Medline,Pubmed
Journal frequency: Monthly
Publisher: Galenos Publishing House.
Publication history: 25 August 2023 till date
Open access: Yes

5. PMCID : PMC10542983
PMID: 37766598
Year: 2023 September
Volume:38(3)

6.  Received for publication :26 May 2023
Accepted: 06 August 2023
Online First: 25 August 2023
Cited as :https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542983

7. AUTHORS
Nidhi Mangla,1 Surbhi Wadhwa,2 Sabita Mishra,2 Sumit Sural,3 and Neelam Vasudeva2
1. Soban Singh Jeena Government Institute of Medical Sciences and Research,
Department of Anatomy, Almora, Uttarakhand, India
2. 2Maulana Azad Medical College, Department of Anatomy, New Delhi, India
3. 3Maulana Azad Medical College, Department of Orthopedics, New Delhi, India
4. corresponding author Address : Maulana Azad Medical College, Department of
Anatomy, New Delhi, India

8. KEY WORDS
Lateral femoral cutaneous nerve,
 Anterior superior iliac spine,
 Inguinal ligament

9. INTRODUCTION
 Lateral femoral cutaneous nerve (LFCN), a sensory nerve of lumbar
plexus, is formed by dorsal branches of second and third lumbar ventral
rami within the substance of psoas major
 It emerges from the lateral border of psoas major at or below level of iliac
crest and courses obliquely across anterior surface of iliacus muscle under
cover of iliac fascia
 pass beneath or through inguinal ligament (IL), a little below and about
one cm medial to anterior superior iliac spine (ASIS) to emerge in the
anterolateral thigh. It divides into branches

10. • Surgeons sometimes are unable to locate the nerve at the
above-described textbook site.
• The nerve is vulnerable to damage during operative procedures
leading to meralgia paraesthetica, pain, dysesthesia or
hyperesthesia along its distribution resulting in mild to
disabling pain.

11. • Need of the study is familiarity with variations in the course of LFCN will
reduce the morbidity associated with orthopedic procedures around the anterior
superior iliac spine (ASIS) and inguinal ligament (IL).
• Aim of the study was to thus, delineate the course and branching pattern of
LFCN in the thigh and especially define morphometric and descriptive relation
of the nerve with reference to sartorius and ASIS.
.

12. MATERIALS AND METHODS
• Study design : Cohort study
• Study participants: Adult human formalin embalmed cadavers-19 male and 6
female
• Study size : 25 adult human cadavers
• Study setting : Department of anatomy Maulana Azad medical college New
Delhi

13. Data collection
• The anterior two-thirds and lateral aspect of the thigh was dissected.
• The course of the nerve/or its branches and their relation to sartorius muscle whether
anterior or passing through its substance was noted and photographed.
• Distance of LFCN from ASIS at the level of IL (Figure 1) was measured with help of
digital vernier calipers.
• The measurements were compared for side-to-side variation. Mean, standard deviation
and range were calculated from the data.

14. Statistical Analysis
• Distance of LFCN from ASIS at the level of IL were compared for any
statistically significant difference between two sexes, as well as for
variation among right and left sides in either sex, using independent
sample t-test [SPSS version 29 (trial version)]. Value of p<0.05 was
considered significant.

15. Ethical consideration
• The cadavers used for the study were donated to Department of Anatomy,
Maulana Azad Medical College, New Delhi. The study was exempt of IRB
approval. All local and international ethical guidelines and laws that pertain to
the use of human cadaveric donors in anatomical research were followed

16. RESULTS
• Mean distance of LFCN from ASIS at IL = 1.73 +/- 1.15 cm
• Ranged from 6.31cm medial to ASIS and 3.71 cm lateral to ASIS
• Side to side variations are not significant
• Gender variations are not significant

17.  47 nerves (94%) passed inferomedial to ASIS
1 (2%) nerve located at ASIS
 2 (4%) nerves lateral to ASIS
 Nerve passes beneath IL in 45 cases (90%)
 Nerve passes through IL in 5 cases (10%)
66% Present within 2 cm of ASIS
26% Present within 2 – 4 cm from ASIS
4% Beyond 4 cm from ASIS

18.  Site of division of LFCN into terminal branches
48% Single trunk of LFCN terminating distal to IL
30% Division at the level of IL
22% Divided proximal to IL

19.  Branching pattern
Among 92% cases
46 limbs (92%) Bifurcation
3 limbs (6%) Trifurcation (all were on left lower limbs in male cadavers)
1 female limb Pentafication at the level of IL
48% Bifurcation site was distal to IL
22% Bifurcation proximal to IL
22% Bifurcation at the level of IL

20. Relation of LFCN to Sartorius muscle
• In 66% of the limbs, LFCN entered the thigh superficial to sartorius in region of IL and
then its branches coursed parallel to lateral border of sartorius. These nerves were
located in intermuscular space between sartorius and tensor fascia lata muscle (TFL)
• 16 limbs the nerve and its branches were superficial to sartorius/TFL throughout its
course
• One LFCN passed through the muscle to enter the thigh.

21. DISCUSSION
a. MEAN DISTANCE OF LFCN FROM ASIS
Current study 1.73 +/- 1.15 cm
Ray et al (2010) 1.87 +/- 0.48 cm
Tomaszewski et al (2016) 3 cm
Chowdhry et al (2015) 4 cm from ASIS

22. b. LFCN located at ASIS
c. LFCN lateral to ASIS
Current study 1 nerve
Dias filho et al (2003) 44 %
Rudin et al (2016) 11%
Current study 4%
Murata Y et al (2002) Nerve injury in this case is
19%

23. • Incidence of trifurcation in the current study – 6%
• Incidence of trifurcation is more in south American population- 24.7%
(Tomaszewski et al 2016)
• Proximal bifurcation will increase risk of iatrogenic nerve injury
(Tomaszewski et al 2016)

24. CONCLUSION
• 66-68% of the patients undergoing surgery using anterior approach to hip are
likely to experience varying degree of meralgia paraesthetica.
• This should serve as a guide to the surgeon in preventing injuries to the nerve
at various anatomical sites, especially the groin and thigh and as a preoperative
counselling point to the patient.
• This would help in better anticipation of the problem, acceptance and
reducing litigation

25. CRITICAL APPRAISAL OF TITLE
• It indicates the focus and need of study
• Title is of simple and meaningful and consist of 16 words
• It reflects the aim of study
• Didn’t mentioned the geographical area

26. CRITICAL APPRAISAL OF ABSTRACT
• Abstract is structured and comprehensive in its content –
consist of objective, method, result and conclusion
• Abstract is informative
• Gives a brief overview of whole study
• Information in the Abstract matches with that present in the text
• Abstract is of appropriate length as it consists of 275 words

27. CRITICAL APPRAISAL OF INTRODUCTION
• It is written in simple, short
• Citations are relevant and pertinent to the study being reported
• Citations are followed with correct references in the list of references

28. CRITICAL APPRAISAL OF MATERIALS AND METHODS
• Study design – Not mentioned properly
• Study setting – Mentioned
• Study duration – Not mentioned
• Sample size is small as the study population is not mentioned
• Method – 1. The procedure is not mentioned in detail
2. Not mentioned the text from where they followed the standard
instructions
• Statistical test is mentioned
• Exclusion inclusion criteria not mentioned

29. .CRITICAL APPRAISAL OF RESULTS
• Usage of self explanatory diagrams
• Figures are numbered and description regarding variations are mentioned. It
is informative
• The results are based on the aim of the study

30. CRITICAL APPRAISAL OF DISCUSSION
• Discussion is simple , short and meaningful
• It highlights the importance of study
• The comparison is logic and has been reasoned properly
• Author didn’t explained the limitations of present study

31. CRITICAL APPRAISAL OF REFERENCES
• Vancouver style of referencing is followed
• Total 29 references cited
• All of them are in English language
• There are references for every citations done in the text part of the
article
• None of the articles are recent
• Year of publications range from1994 - 2017

32. CRITICAL REFLECTION
• Generalizability : Good
• It has good public health significance
• Didn’t mentioned the limitations of the study
• Didn’t mentioned the future scope of study