JOURNAL ARTICLE

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

Yuwei Cai, Chunlin Hou
Chinese Journal of Reparative and Reconstructive Surgery 2015, 29 (1): 58-62
26455174

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.

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