Foot Reanimation Using Double Nerve Transfer to Deep Peroneal Nerve: A Novel Technique for Treatment of Neurologic Foot Drop

2021 ◽  
pp. 107110072199779
Author(s):  
Mohamed El-Taher ◽  
Asser Sallam ◽  
Mohamed Saleh ◽  
Ahmed Metwally
Keyword(s):  
Peroneal Nerve ◽  
Pain Perception ◽  
Nerve Transfer ◽  
High Energy ◽  
Primary Objective ◽  
Motor Recovery ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Level Of Evidence ◽  
Ankle Motion

Background: Our primary objective was to assess the efficacy of a new technique for foot reanimation in patients with neurologic foot drop using double nerve transfer from the tibial to the deep peroneal nerve. Our secondary objective was to document the technical nuances of our technique. Methods: Thirty-one patients with common peroneal nerve injury between October 2015 and March 2019 were prospectively enrolled in the study. Patients underwent a transfer of the tibial nerve branches to flexor digitorum longus and lateral head of gastrocnemius to the deep peroneal nerve. Motor recovery, range of ankle dorsiflexion, pain, leg girth, and complications were examined as outcome measures. The modified Medical Research Council (MRC) scale was adopted to assess the motor power recovery. All patients were followed up for a minimum of 1 year. Results: Motor recovery of M3 or M4 grade of tibialis anterior, extensor hallucis longus, and extensor digitorum longus was achieved in 15 of 31, 13 of 31, and 12 of 31 patients, respectively. Those patients could discontinue use of orthosis. Most patients with high-energy traumas or knee-level injuries failed to recover antigravity function. Only 2 patients reported weak postoperative toe plantarflexion. Our patients achieved significant improvement of the pain perception and range of active ankle motion at the final follow-up. Conclusion: The double nerve transfer technique represented a feasible and safe surgical option. It has been shown to improve function in some patients with neurologic foot drop resulting from a less than 12-month injury of the deep peroneal nerve. Level of Evidence: Level IV, therapeutic.

Soleus nerve transfer to deep peroneal nerve for treatment of foot drop

2020 ◽  
Vol 78 ◽  
pp. 159-163 ◽  
Author(s):  
Mohammadreza Emamhadi ◽  
Amin Naseri ◽  
Iraj Aghaei ◽  
Morteza Ashrafi ◽  
Roxana Emamhadi ◽  
...  
Keyword(s):  
Peroneal Nerve ◽  
Nerve Transfer ◽  
Foot Drop ◽  
Deep Peroneal Nerve

scholarly journals Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop

Neurosurgery ◽  
2013 ◽  
Vol 73 (4) ◽  
pp. 609-616 ◽  
Author(s):  
Leandro Pretto Flores ◽  
Roberto Sérgio Martins ◽  
Mario Gilberto Siqueira
Keyword(s):  
Medical Research ◽  
Soleus Muscle ◽  
Peroneal Nerve ◽  
Research Council ◽  
Medical Research Council ◽  
Tibial Nerve ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Motor Branch ◽  
Patient Reported

Abstract BACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.

scholarly journals Peroneal nerve decompression

2018 ◽  
Vol 44 (videosuppl1) ◽  
pp. V6 ◽  
Author(s):  
Mark Corriveau ◽  
Jacob D. Lescher ◽  
Amgad S. Hanna
Keyword(s):  
Peroneal Nerve ◽  
Foot Drop ◽  
Superficial Peroneal Nerve ◽  
Fibular Head ◽  
Deep Peroneal Nerve ◽  
Operative Techniques ◽  
Key Steps ◽  
Adequate Decompression ◽  
Nerve Release ◽  
Fibular Nerve

Peroneal neuropathy is a common pathology encountered by neurosurgeons. Symptoms include pain, numbness, and foot drop. When secondary to compression of the nerve at the fibular head, peroneal (fibular) nerve release is a low-risk procedure that can provide excellent results with pain relief and return of function. In this video, the authors highlight key operative techniques to ensure adequate decompression of the nerve while protecting the 3 major branches, including the superficial peroneal nerve, deep peroneal nerve, and recurrent genicular (articular) branches. Key steps include positioning, circumferential nerve dissection, fascial opening, isolation of the major branches, and closure.The video can be found here: https://youtu.be/0y9oE8w1FIU.

Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma

2021 ◽  
pp. 175319342110396
Author(s):  
Dominic M. Power ◽  
Devanshi Jimulia ◽  
Paul Malone ◽  
Colin Shirley ◽  
Tahseen Chaudhry
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Nerve Transfer ◽  
Suprascapular Nerve ◽  
High Energy ◽  
Pathological Findings ◽  
Level Of Evidence ◽  
Suprascapular Notch ◽  
High Energy Trauma ◽  
Spinal Accessory

The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch. Over the next 6 years we have used this approach for 20 explorations after high-energy trauma. In 7/20 we identified abnormalities at the level of the suprascapular ligament, which we would not have identified with an anterior approach: there were two ruptures, two neuromas-in-continuity and three cases of scar encasement, necessitating neurolysis. Nerve transfer could be undertaken distal to the suprascapular notch, bypassing the site of injury. These pathological findings support the wider adoption of the posterior approach in cases of high-energy trauma. Level of evidence: IV

scholarly journals Deep Peroneal Nerve Palsy Caused by an Extraneural Ganglion Cyst: A Rare Case

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Dimitrios Nikolopoulos ◽  
George Safos ◽  
Neoptolemos Sergides ◽  
Petros Safos
Keyword(s):  
Peroneal Nerve ◽  
Ganglion Cyst ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Peripheral Neuropathies ◽  
Tibiofibular Syndesmosis ◽  
Deep Peroneal Nerve ◽  
Intraneural Ganglion ◽  
Ganglion Cysts ◽  
The Common

Lower extremities peripheral neuropathies caused by ganglion cysts are rare. The most frequent location of occurrence is the common peroneal nerve and its branches, at the level of the fibular neck. We report the case of a 57-year-old patient admitted with foot drop, due to an extraneural ganglion of the upper tibiofibular syndesmosis, compressing the deep branch of the peroneal nerve. Although there have been many previous reports of intraneural ganglion involvement with the lower limb nerves, to our knowledge, this is the second reported occurrence of an extraneural ganglion distinctly localized to the upper tibiofibular syndesmosis and palsying deep peroneal nerve. The diagnosis was made preoperatively using MRI. The common peroneal nerve and its branches were recognized and traced to its bifurcation during the operation, and the ganglion cyst was removed. Two months after surgery, the patient was pain-free and asymptomatic except for cutaneous anesthesia in the distribution of the deep peroneal nerve.

On “Successful Management of Foot Drop by Nerve Transfers to the Deep Peroneal Nerve” (J Reconstr Microsurg 2008;24:419–428)

2010 ◽  
Vol 26 (06) ◽  
pp. 425-426 ◽  
Author(s):  
Ramin Ipaktchi ◽  
Christine Radtke ◽  
Matthias Aust ◽  
Marc Busche ◽  
Peter Vogt
Keyword(s):  
Peroneal Nerve ◽  
Foot Drop ◽  
Deep Peroneal Nerve ◽  
Successful Management ◽  
Nerve Transfers
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