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Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique.
Neurochirurgie. 2015 Aug; 61(4):292-7.N

Abstract

INTRODUCTION

Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion.

SURGICAL TECHNIQUE

The transposition of the lateral head of the gastrocnemius muscle to the tendons of the anterior tibial muscle group, with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy is performed in one stage. It includes 10 key steps which are described in this article. Since 1994, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We review the indications and limitations of the technique.

CONCLUSION

Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction.

Authors+Show Affiliations

Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland. Electronic address: franckleclere@yahoo.fr.Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26071175

Citation

Leclère, F M., et al. "Neurotized Lateral Gastrocnemius Muscle Transfer for Persistent Traumatic Peroneal Nerve Palsy: Surgical Technique." Neuro-Chirurgie, vol. 61, no. 4, 2015, pp. 292-7.
Leclère FM, Badur N, Mathys L, et al. Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique. Neurochirurgie. 2015;61(4):292-7.
Leclère, F. M., Badur, N., Mathys, L., & Vögelin, E. (2015). Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique. Neuro-Chirurgie, 61(4), 292-7. https://doi.org/10.1016/j.neuchi.2014.08.001
Leclère FM, et al. Neurotized Lateral Gastrocnemius Muscle Transfer for Persistent Traumatic Peroneal Nerve Palsy: Surgical Technique. Neurochirurgie. 2015;61(4):292-7. PubMed PMID: 26071175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique. AU - Leclère,F M, AU - Badur,N, AU - Mathys,L, AU - Vögelin,E, Y1 - 2015/06/10/ PY - 2014/04/22/received PY - 2014/07/30/revised PY - 2014/08/28/accepted PY - 2015/6/14/entrez PY - 2015/6/14/pubmed PY - 2016/7/28/medline KW - Flexion dorsale active du pied KW - Foot drop KW - Gastrocnemius muscle transfer KW - Lower limb KW - Lésion nerveuse KW - Membre inférieur KW - Nerf fibulaire KW - Nerf sciatique poplité externe KW - Nerve injury KW - Nerve transfer KW - Neurotisation KW - Neurotization KW - Peroneal nerve KW - Pied ballant KW - Transfert de muscle jumeau SP - 292 EP - 7 JF - Neuro-Chirurgie JO - Neurochirurgie VL - 61 IS - 4 N2 - INTRODUCTION: Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion. SURGICAL TECHNIQUE: The transposition of the lateral head of the gastrocnemius muscle to the tendons of the anterior tibial muscle group, with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy is performed in one stage. It includes 10 key steps which are described in this article. Since 1994, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We review the indications and limitations of the technique. CONCLUSION: Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction. SN - 1773-0619 UR - https://www.unboundmedicine.com/medline/citation/26071175/Neurotized_lateral_gastrocnemius_muscle_transfer_for_persistent_traumatic_peroneal_nerve_palsy:_Surgical_technique_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0028-3770(14)00264-1 DB - PRIME DP - Unbound Medicine ER -