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Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study.
Clin Anat. 2004 Apr; 17(3):201-5.CA

Abstract

Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury.

Authors+Show Affiliations

Mayo Medical School, Mayo Foundation, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15042567

Citation

Bodily, Kale D., et al. "Restoration of Motor Function of the Deep Fibular (peroneal) Nerve By Direct Nerve Transfer of Branches From the Tibial Nerve: an Anatomical Study." Clinical Anatomy (New York, N.Y.), vol. 17, no. 3, 2004, pp. 201-5.
Bodily KD, Spinner RJ, Bishop AT. Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study. Clin Anat. 2004;17(3):201-5.
Bodily, K. D., Spinner, R. J., & Bishop, A. T. (2004). Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study. Clinical Anatomy (New York, N.Y.), 17(3), 201-5.
Bodily KD, Spinner RJ, Bishop AT. Restoration of Motor Function of the Deep Fibular (peroneal) Nerve By Direct Nerve Transfer of Branches From the Tibial Nerve: an Anatomical Study. Clin Anat. 2004;17(3):201-5. PubMed PMID: 15042567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restoration of motor function of the deep fibular (peroneal) nerve by direct nerve transfer of branches from the tibial nerve: an anatomical study. AU - Bodily,Kale D, AU - Spinner,Robert J, AU - Bishop,Allen T, PY - 2004/3/26/pubmed PY - 2004/9/24/medline PY - 2004/3/26/entrez SP - 201 EP - 5 JF - Clinical anatomy (New York, N.Y.) JO - Clin Anat VL - 17 IS - 3 N2 - Traction injuries of the common fibular (peroneal) nerve frequently result in significant morbidity due to tibialis anterior muscle paralysis and the associated loss of ankle dorsiflexion. Because current treatment options are often unsuccessful or unsatisfactory, other treatment approaches need to be explored. In this investigation, the anatomical feasibility of an alternative option, consisting of nerve transfer of motor branches from the tibial nerve to the deep fibular nerve, was studied. In ten cadaveric limbs, the branching pattern, length, and diameter of motor branches of the tibial nerve in the proximal leg were characterized; nerve transfer of each of these motor branches was then simulated to the proximal deep fibular nerve. A consistent, reproducible pattern of tibial nerve innervation was seen with minor variability. Branches to the flexor hallucis longus and flexor digitorum longus muscles were determined to be adequate, based on their branch point, branch pattern, and length, for direct nerve transfer in all specimens. Other branches, including those to the tibialis posterior, popliteus, gastrocnemius, and soleus muscles were not consistently adequate for direct nerve transfer for injuries extending to the bifurcation of the common fibular nerve or distal to it. For neuromas of the common fibular nerve that do not extend as far distally, branches to the soleus and lateral head of the gastrocnemius may be adequate for direct transfer if the intramuscular portions of these nerves are dissected. This study confirms the anatomical feasibility of direct nerve transfer using nerves to toe-flexor muscles as a treatment option to restore ankle dorsiflexion in cases of common fibular nerve injury. SN - 0897-3806 UR - https://www.unboundmedicine.com/medline/citation/15042567/Restoration_of_motor_function_of_the_deep_fibular__peroneal__nerve_by_direct_nerve_transfer_of_branches_from_the_tibial_nerve:_an_anatomical_study_ L2 - https://doi.org/10.1002/ca.10189 DB - PRIME DP - Unbound Medicine ER -