Common Peroneal Nerve Grafting to Repair the Tibial Nerve as a Salvage Procedure in the Treatment of Sciatic Nerve Injury with Long-Segment DefectsFunding This work was supported by the Shuguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission (grant number 15SG34) and the Project of Research doctor of Shanghai Changzheng Hospital (grant 201712).
28 December 2017
07 April 2018
21 May 2018 (online)
Background In sciatic nerve neuropathies, when direct nerve repair is impossible due to a large gap, nerve grafting can be performed. However, the diameters of traditional autologous nerve grafts are too small to cover the whole cross-sectional area of the sciatic nerve. The aim of this study is to present the outcome of common peroneal nerve grafting to repair the tibial nerve in eight patients with sciatic nerve injuries, showing long defects of more than 10 cm.
Methods Between 2007 and 2013, the common peroneal nerve was used as an autograft to repair the tibial nerve in eight patients with complete high sciatic nerve injury with long defects. There were 6 men and 2 women with an average age of 31 years (range: 17–44 years). Muscle strength was evaluated using the British Medical Research Council scale. The Semmes–Weinstein monofilament test was used for sensory evaluation.
Results The follow-up time for patients ranged from 36 to 60 months, with an average of 48.75 months. Tibial nerve motor function was “good” or “very good” (M3–M4) in five out of eight patients (55.6%). Plantar flexion was not adequate in the rest of the patients. Sensory recovery was “good” or “very good” (S2–S3) in six patients and “inadequate” (S4) in two patients.
Conclusion In cases where there were extensive gaps in the sciatic nerve, using the common peroneal nerve as an autograft to repair the tibial nerve provides an alternative to traditional nerve graft repair.
- 1 Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998; 45 (01) 116-122
- 2 Lin H, Xu Z, Liu Y, Chen A, Hou C. The effect of severing L6 nerve root of the sacral plexus on lower extremity function: an experimental study in rhesus monkeys. Neurosurgery 2012; 70 (01) 170-177
- 3 Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve 2000; 23 (06) 863-873
- 4 Roganovic Z, Pavlicevic G. Difference in recovery potential of peripheral nerves after graft repairs. Neurosurgery 2006; 59 (03) 621-633
- 5 Kim DH, Murovic JA, Tiel RL, Kline DG. Management and outcomes in 318 operative common peroneal nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 2004; 54 (06) 1421-1428
- 6 Kim DH, Ryu S, Tiel RL, Kline DG. Surgical management and results of 135 tibial nerve lesions at the Louisiana State University Health Sciences Center. Neurosurgery 2003; 53 (05) 1114-1124
- 7 Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg 2004; 101 (01) 8-17
- 8 Matejcík V. Peripheral nerve reconstruction by autograft. Injury 2002; 33 (07) 627-631
- 9 Aydin A, Ozkan T, Aydin HU. , et al. The results of surgical repair of sciatic nerve injuries. Acta Orthop Traumatol Turc 2010; 44 (01) 48-53
- 10 Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med 2012; 37 (04) 410-414
- 11 Roganović Z, Pavlićević G, Petković S. Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs. J Neurosurg 2005; 103 (04) 622-629
- 12 Gousheh J, Babaei A. A new surgical technique for the treatment of high common peroneal nerve palsy. Plast Reconstr Surg 2002; 109 (03) 994-998
- 13 Samardzić MM, Rasulić LG, Vucković CD. Missile injuries of the sciatic nerve. Injury 1999; 30 (01) 15-20
- 14 Wood MB. Peroneal nerve repair. Surgical results. Clin Orthop Relat Res 1991; (267) 206-210
- 15 Gousheh J, Arasteh E, Beikpour H. Therapeutic results of sciatic nerve repair in Iran-Iraq war casualties. Plast Reconstr Surg 2008; 121 (03) 878-886
- 16 Kalomiri DE, Soucacos PN, Beris AE. Nerve grafting in peripheral nerve microsurgery of the upper extremity. Microsurgery 1994; 15 (07) 506-511
- 17 Terzis JK, Kokkalis ZT. Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg 2009; 123 (03) 927-938
- 18 Kline DG. Nerve surgery as it is now and as it may be. Neurosurgery 2000; 46 (06) 1285-1293
- 19 Kim DH, Kline DG. Management and results of peroneal nerve lesions. Neurosurgery 1996; 39 (02) 312-319
- 20 Lee YH, Chung MS, Gong HS, Chung JY, Park JH, Baek GH. Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. J Hand Surg Am 2008; 33 (01) 83-86