Chinese Journal of Reparative and Reconstructive Surgery
Supervisor： National Health Commission of the People's Republic of ChinaSponsor： Chinese Association of Rehabilitation Medicine , Sichuan University Editor-in-chief：Bin Shen Publishing period：
Monthly
ISSN：1002-1892CN：51-1372/R
Objective To explore the feasibility of transposition of the proximal motor branches from tibial nerve (TN) as direct donors to suture the deep peroneal nerve (DPN) so as to provide a basis for surgical treatment of high fibular nerve injury.
Methods Nineteen lower limb specimens were selected from 3 donors who experienced high-level amputation (2 left limbs and 1 right limb) and 8 fresh frozen cadavers (8 left limbs and 8 right limbs). The length and diameter of the three motor branches from TN (soleus, medial gastrocnemius, and lateral gastrocnemius) and the distance from the initial points to the branch point of the common peroneal nerve (CPN), as well as the length and diameter of the noninvasive separated bundles of DPN, then the feasibility of tensionless suturing between the donor nerves and the DPN bundle was evaluated. At last, part of the nerve tissue was cut out for HE and Acetylcholine esterase staining observation and the nerve fiber count.
Results Gross anatomic observation indicated the average distance from the initial points of the three donor nerves to the branch point of the CPN was (71.44±2.76) (medial gastrocnemius), (75.66±3.20) (lateral gastrocnemius), and (67.50±3.22) mm (soleus), respectively. The three donor nerves and the DPN bundles had a mean length of (31.09±2.01), (38.44±2.38), (59.18±2.72), and (66.44±2.85) mm and a mean diameter of (1.72±0.08), (1.88±0.08), (2.10±0.10), and (2.14±0.12) mm, respectively. The histological observation showed the above-mentioned four nerve bundles respectively had motor fiber number of 2 032±58, 2 186±24, 3 102±85, and 3 512±112. Soleus nerve had similar diameter and number of motor fibers to DPN bundles (P>0.05), but the diameter and number of motor fibers of the medial and lateral gastrocnemius were significantly less than those of DPN bundles (P<0.05).
Conclusion All of the three motor branches from TN at popliteal fossa can be used as direct donors to suture the DPN for treating high CPN injuries. The nerve to the soleus muscle should be the first choice.
Citation：CAIYuwei, HOUChunlin. A FEASIBILITY STUDY ON TRANSPOSITION OF PROXIMAL MOTOR BRANCHES FROM TIBIAL NERVE TO RECONSTRUCT DEEP FIBULAR NERVE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 58-62. doi: 10.7507/1002-1892.20150014Copy
Copyright ? the editorial department of Chinese Journal of Reparative and Reconstructive Surgery of West China Medical Publisher. All rights reserved
1.
Wilkinson MC, Birch R. Repair of the common peroneal nerve. J Bone Joint Surg (Br), 1995, 77(3):501-503.
2.
Ferraresi S, Garozzo D, Buffatti P. Common peroneal nerve injuries:results with one-stage nerve repair and tendon transfer. Neurosurg Rev, 2003, 26(3):175-179.
Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg, 2008, 12(1):20-33.
6.
Mackinnon SE, Dellon AL, O'Brien JP, et al. Selection of optimal axon ratio for nerve regeneration. Ann Plast Surg, 1989, 23(2):129-134.
7.
White CP, Cooper MJ, Bain JR, et al. Axon counts of potential nerve transfer donors for peroneal nerve reconstruction. Can J Plast Surg, 2012, 20(1):24-27.
8.
Flores LP. Proximal motor branches from the tibial nerve as direct donors to restore function of the deep fibular nerve for treatment of high sciaticnerve injuries:a cadaveric feasibility study. Neurosurgery, 2009, 65(6 Suppl):218-225.
Kim DH, Murovic JA, Tiel R, et al. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg, 2004, 101(1):8-17.
11.
Büyükmumcu M, Ustün ME, Seker M, et al. The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve:an anatomical approach. J Anat, 1999, 194(Pt 2):309-312.
12.
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):201-205.
5. Mackinnon SE, Colbert SH. Nerve transfers in the hand and upper extremity surgery. Tech Hand Up Extrem Surg, 2008, 12(1):20-33.
6. Mackinnon SE, Dellon AL, O'Brien JP, et al. Selection of optimal axon ratio for nerve regeneration. Ann Plast Surg, 1989, 23(2):129-134.
7. White CP, Cooper MJ, Bain JR, et al. Axon counts of potential nerve transfer donors for peroneal nerve reconstruction. Can J Plast Surg, 2012, 20(1):24-27.
8. Flores LP. Proximal motor branches from the tibial nerve as direct donors to restore function of the deep fibular nerve for treatment of high sciaticnerve injuries:a cadaveric feasibility study. Neurosurgery, 2009, 65(6 Suppl):218-225.
10. Kim DH, Murovic JA, Tiel R, et al. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg, 2004, 101(1):8-17.
11. Büyükmumcu M, Ustün ME, Seker M, et al. The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve:an anatomical approach. J Anat, 1999, 194(Pt 2):309-312.
12. 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):201-205.
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Citation：CAIYuwei, HOUChunlin. A FEASIBILITY STUDY ON TRANSPOSITION OF PROXIMAL MOTOR BRANCHES FROM TIBIAL NERVE TO RECONSTRUCT DEEP FIBULAR NERVE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 58-62. doi: 10.7507/1002-1892.20150014
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