Distal Nerve Transfers in High Peroneal Nerve Lesions: An Anatomical Feasibility Study

被引：2

作者：

Salminger, Stefan ^{[1
,2
]}

Gstoettner, Clemens ^{[2
,3
]}

Hirtler, Lena ^{[4
]}

Blumer, Roland ^{[4
]}

Fuchssteiner, Christoph ^{[4
]}

Laengle, Gregor ^{[2
,3
]}

Mayer, Johannes A. A. ^{[2
,5
]}

Bergmeister, Konstantin D. D. ^{[2
,3
,5
]}

Weninger, Wolfgang J. J. ^{[4
]}

Aszmann, Oskar C. C. ^{[2
,3
]}

机构：

[1] AUVA Trauma Hosp Lorenz Bohler, European Hand Trauma Ctr, Donaueschingenstr 13, A-1200 Vienna, Austria

[2] Med Univ Vienna, Clin Lab Bion Extrem Reconstruct, Dept Plast & Reconstruct Surg, A-1090 Vienna, Austria

[3] Med Univ Vienna, Dept Plast & Reconstruct Surg, A-1090 Vienna, Austria

[4] Med Univ Vienna, Ctr Anat & Cell Biol, Div Anat, A-1090 Vienna, Austria

[5] Karl Landsteiner Univ Hlth Sci, Dept Plast Aesthet & Reconstruct Surg, Univ Hosp St Poelten, A-3100 Krems, Austria

来源：

JOURNAL OF PERSONALIZED MEDICINE | 2023年 / 13卷 / 02期

关键词：

peroneal nerve lesion; drop foot; nerve transfer; axon count; TIBIAL NERVE; ANTERIOR; MANAGEMENT; INJURY; REPAIR; PALSY;

D O I：

10.3390/jpm13020344

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

The peroneal nerve is one of the most commonly injured nerves of the lower extremity. Nerve grafting has been shown to result in poor functional outcomes. The aim of this study was to evaluate and compare anatomical feasibility as well as axon count of the tibial nerve motor branches and the tibialis anterior motor branch for a direct nerve transfer to reconstruct ankle dorsiflexion. In an anatomical study on 26 human body donors (52 extremities) the muscular branches to the lateral (GCL) and the medial head (GCM) of the gastrocnemius muscle, the soleus muscle (S) as well as the tibialis anterior muscle (TA) were dissected, and each nerve's external diameter was measured. Nerve transfers from each of the three donor nerves (GCL, GCM, S) to the recipient nerve (TA) were performed and the distance between the achievable coaptation site and anatomic landmarks was measured. Additionally, nerve samples were taken from eight extremities, and antibody as well immunofluorescence staining were performed, primarily evaluating axon count. The average diameter of the nerve branches to the GCL was 1.49 +/- 0.37, to GCM 1.5 +/- 0.32, to S 1.94 +/- 0.37 and to TA 1.97 +/- 0.32 mm, respectively. The distance from the coaptation site to the TA muscle was 43.75 +/- 12.1 using the branch to the GCL, 48.31 +/- 11.32 for GCM, and 19.12 +/- 11.68 mm for S, respectively. The axon count for TA was 1597.14 +/- 325.94, while the donor nerves showed 297.5 +/- 106.82 (GCL), 418.5 +/- 62.44 (GCM), and 1101.86 +/- 135.92 (S). Diameter and axon count were significantly higher for S compared to GCL as well as GCM, while regeneration distance was significantly lower. The soleus muscle branch exhibited the most appropriate axon count and nerve diameter in our study, while also reaching closest to the tibialis anterior muscle. These results indicate the soleus nerve transfer to be the favorable option for the reconstruction of ankle dorsiflexion, in comparison to the gastrocnemius muscle branches. This surgical approach can be used to achieve a biomechanically appropriate reconstruction, in contrast to tendon transfers which generally only achieve weak active dorsiflexion.

引用

页数：10

共 21 条

[1] Transfer of Soleus Muscular Branch of Tibial Nerve to Deep Fibular Nerve to Repair Foot Drop After Common Peroneal Nerve Injury: A Retrospective Study [J].