nerve transfer of motor branches from the tibial nerve to the deep fibular nerve

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Research from Clin Anat. Apr 2004 17(3):201-5.

Restoration of motor function of the deep fibular (peroneal) nerve by

direct nerve transfer of branches from the tibial nerve: an anatomical

study.

Bodily KD, Spinner RJ, Bishop AT.

Mayo Medical School, Mayo Foundation, Rochester, Minnesota 55905, USA.

Traction injuries of the common fibular (peroneal) nerve frequently

result in significant morbidity due to tibialis anterior muscle

paralysis and the associated loss of ankle dorsiflexion. Because current

treatment options are often unsuccessful or unsatisfactory, other

treatment approaches need to be explored.

In this investigation, the anatomical feasibility of an alternative

option, consisting of nerve transfer of motor branches from the tibial

nerve to the deep fibular nerve, was studied. In ten cadaveric limbs,

the branching pattern, length, and diameter of motor branches of the

tibial nerve in the proximal leg were characterized; nerve transfer of

each of these motor branches was then simulated to the proximal deep

fibular nerve. A consistent, reproducible pattern of tibial nerve

innervation was seen with minor variability. Branches to the flexor

hallucis longus and flexor digitorum longus muscles were determined to

be adequate, based on their branch point, branch pattern, and length,

for direct nerve transfer in all specimens. Other branches, including

those to the tibialis posterior, popliteus, gastrocnemius, and soleus

muscles were not consistently adequate for direct nerve transfer for

injuries extending to the bifurcation of the common fibular nerve or

distal to it. For neuromas of the common fibular nerve that do not

extend as far distally, branches to the soleus and lateral head of the

gastrocnemius may be adequate for direct transfer if the intramuscular

portions of these nerves are dissected.

This study confirms the anatomical feasibility of direct nerve transfer

using nerves to toe-flexor muscles as a treatment option to restore

ankle dorsiflexion in cases of common fibular nerve injury.