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Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions.
Neurosurgery. 2009 Oct; 65(4 Suppl):A18-23.N

Abstract

OBJECTIVE

With the use of data from 3 Louisiana State University Health Sciences Center (LSUHSC) publications, various parameters for buttock/thigh-level sciatic nerve and tibial and common peroneal divisions/nerve injuries were summarized, and outcomes were compared.

METHODS

Data from 806 buttock/thigh-level sciatic nerve and tibial and common peroneal division/nerve injury repairs were summarized. Lesion types, repair techniques, and outcomes were compared.

RESULTS

Acute lacerations undergoing suture repair were best for the thigh-then-buttock-level tibial (93%/73%) and then same-level common peroneal divisions (69%/30%); at the knee level, tibial outcomes (100%) were better than those for the common peroneal nerve (CPN) (84%). Secondary graft repairs for lacerations had good outcomes for the thigh-then-buttock-level tibial (80%/62%), followed by common peroneal divisions at the same levels (45%/24%). The knee/leg-level tibial nerve (94%) did better than the CPN (40%) here. In-continuity lesions with positive intraoperative nerve action potentials underwent neurolysis with better results for the thigh-then-buttock-level tibial division (95%/86%) than for same-level CPN (78%/69%). The knee/leg-level tibial nerve did better than the CPN (95%/93%).

CONCLUSION

Better recovery of buttock- and thigh-level tibial division/nerve occurs because: 1) the CPN is lateral and thus vulnerable to a more severe injury; 2) the tibial nerve is more elastic at impact owing to its singular-fixation site (the CPN has a dual fixation); 3) the tibial nerve has a better blood supply and regeneration; 4) the tibial nerve has a higher force-absorbing fascicle/connective tissue count than the CPN; and 5) the tibial nerve-innervated gastrocnemius soleus requires less reinnervation for functional contraction than deep peroneal branches, which innervate long, thin extensor muscles at multiple sites and require coordinated nerve input for effective contraction.

Authors+Show Affiliations

Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA. murovic@stanford.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19927065

Citation

Murovic, Judith A.. "Lower-extremity Peripheral Nerve Injuries: a Louisiana State University Health Sciences Center Literature Review With Comparison of the Operative Outcomes of 806 Louisiana State University Health Sciences Center Sciatic, Common Peroneal, and Tibial Nerve Lesions." Neurosurgery, vol. 65, no. 4 Suppl, 2009, pp. A18-23.
Murovic JA. Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions. Neurosurgery. 2009;65(4 Suppl):A18-23.
Murovic, J. A. (2009). Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions. Neurosurgery, 65(4 Suppl), A18-23. https://doi.org/10.1227/01.NEU.0000339123.74649.BE
Murovic JA. Lower-extremity Peripheral Nerve Injuries: a Louisiana State University Health Sciences Center Literature Review With Comparison of the Operative Outcomes of 806 Louisiana State University Health Sciences Center Sciatic, Common Peroneal, and Tibial Nerve Lesions. Neurosurgery. 2009;65(4 Suppl):A18-23. PubMed PMID: 19927065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions. A1 - Murovic,Judith A, PY - 2009/11/21/entrez PY - 2009/12/16/pubmed PY - 2010/3/17/medline SP - A18 EP - 23 JF - Neurosurgery JO - Neurosurgery VL - 65 IS - 4 Suppl N2 - OBJECTIVE: With the use of data from 3 Louisiana State University Health Sciences Center (LSUHSC) publications, various parameters for buttock/thigh-level sciatic nerve and tibial and common peroneal divisions/nerve injuries were summarized, and outcomes were compared. METHODS: Data from 806 buttock/thigh-level sciatic nerve and tibial and common peroneal division/nerve injury repairs were summarized. Lesion types, repair techniques, and outcomes were compared. RESULTS: Acute lacerations undergoing suture repair were best for the thigh-then-buttock-level tibial (93%/73%) and then same-level common peroneal divisions (69%/30%); at the knee level, tibial outcomes (100%) were better than those for the common peroneal nerve (CPN) (84%). Secondary graft repairs for lacerations had good outcomes for the thigh-then-buttock-level tibial (80%/62%), followed by common peroneal divisions at the same levels (45%/24%). The knee/leg-level tibial nerve (94%) did better than the CPN (40%) here. In-continuity lesions with positive intraoperative nerve action potentials underwent neurolysis with better results for the thigh-then-buttock-level tibial division (95%/86%) than for same-level CPN (78%/69%). The knee/leg-level tibial nerve did better than the CPN (95%/93%). CONCLUSION: Better recovery of buttock- and thigh-level tibial division/nerve occurs because: 1) the CPN is lateral and thus vulnerable to a more severe injury; 2) the tibial nerve is more elastic at impact owing to its singular-fixation site (the CPN has a dual fixation); 3) the tibial nerve has a better blood supply and regeneration; 4) the tibial nerve has a higher force-absorbing fascicle/connective tissue count than the CPN; and 5) the tibial nerve-innervated gastrocnemius soleus requires less reinnervation for functional contraction than deep peroneal branches, which innervate long, thin extensor muscles at multiple sites and require coordinated nerve input for effective contraction. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/19927065/Lower_extremity_peripheral_nerve_injuries:_a_Louisiana_State_University_Health_Sciences_Center_literature_review_with_comparison_of_the_operative_outcomes_of_806_Louisiana_State_University_Health_Sciences_Center_sciatic_common_peroneal_and_tibial_nerve_lesions_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000339123.74649.BE DB - PRIME DP - Unbound Medicine ER -