A FEASIBILITY STUDY ON TRANSPOSITION OF PROXIMAL MOTOR BRANCHES FROM TIBIAL NERVE TO RECONSTRUCT DEEP FIBULAR NERVE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAIYuwei ,  HOUChunlin

Department of Orthopaedics, Changzheng Hospital of Second Military Medical University, Shanghai, 200003, P. R. China;

Corresponding author：

HOUChunlin, Email: chunlin_hou@163.com

Keywords：

Never transposition; Common peroneal nerve injury; Tibial nerve branch; Lower extremity nerve function reconstruction

DOI：

10.7507/1002-1892.20150014

Video：

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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: 10.7507/1002-1892.20150014 Copy

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.
3.	侯春林, 王诗波, 陈爱民, 等. 坐骨神经损伤的手术治疗. 中华创伤杂志, 2002, 18(9):530-532.
4.	徐雷, 顾玉东, 徐建光, 等. 经椎体前路移位健侧颈7神经根修复臂丛上中干根性撕脱伤. 中华手外科杂志, 2007, 23(6):345-348.
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.
9.	谢颍涛, 顾立强, 林晓岗. 髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析. 中华创伤骨科杂志, 2005, 7(7):660-663.
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.
13.	李明恒, 张力成, 陈维波, 等. 胫神经肌支移位修复腓深神经的显微解剖. 中华显微外科杂志, 2011, 34(5):390-393.
14.	钟世镇, 何蕴韶, 韩震, 等. 选择周围神经缝合方式的解剖学依据. 临床解剖学杂志, 1986, 4(1):3-7.
15.	杨勇, 陈山林, 荣艳波,等. 端侧吻合与自体神经移植治疗周围神经缺损的比较. 北京大学学报:医学版, 2012, 44(6):962-965.
16.	柳大烈, 李希军, 单磊, 等. 腓肠肌内侧头肌支神经切断小腿减肥术应用解剖及临床效果观察. 中华整形外科杂志, 2007, 23(2):125-127.

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.
3. 侯春林, 王诗波, 陈爱民, 等. 坐骨神经损伤的手术治疗. 中华创伤杂志, 2002, 18(9):530-532.
4. 徐雷, 顾玉东, 徐建光, 等. 经椎体前路移位健侧颈7神经根修复臂丛上中干根性撕脱伤. 中华手外科杂志, 2007, 23(6):345-348.
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.
9. 谢颍涛, 顾立强, 林晓岗. 髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析. 中华创伤骨科杂志, 2005, 7(7):660-663.
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.
13. 李明恒, 张力成, 陈维波, 等. 胫神经肌支移位修复腓深神经的显微解剖. 中华显微外科杂志, 2011, 34(5):390-393.
14. 钟世镇, 何蕴韶, 韩震, 等. 选择周围神经缝合方式的解剖学依据. 临床解剖学杂志, 1986, 4(1):3-7.
15. 杨勇, 陈山林, 荣艳波,等. 端侧吻合与自体神经移植治疗周围神经缺损的比较. 北京大学学报:医学版, 2012, 44(6):962-965.
16. 柳大烈, 李希军, 单磊, 等. 腓肠肌内侧头肌支神经切断小腿减肥术应用解剖及临床效果观察. 中华整形外科杂志, 2007, 23(2):125-127.

Chinese Journal of Reparative and Reconstructive Surgery

A FEASIBILITY STUDY ON TRANSPOSITION OF PROXIMAL MOTOR BRANCHES FROM TIBIAL NERVE TO RECONSTRUCT DEEP FIBULAR NERVE

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