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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2022; 07(02): e35-e43
DOI: 10.1055/s-0041-1740979
Case Report

End-to-Side Nerve Transfer for the Management of Chronic Leg Compartment Ankle Dorsiflexion Weakness

Edgardo R. Rodriguez-Collazo
1   Department of Surgery, Amita Health Saint Joseph's Hospital, Chicago, Illinois
,
Asim A.Z. Raja   *
2   Department of Orthopedics and Rehabilitation, Womack Army Medical Center, Fort Bragg, North Carolina
,
Shawn Christopher Ward
3   Department of Surgery, Mercy Health Saint Rita's Medical Center Lima OH, Lima, Ohio
,
Stephanie Oexeman
1   Department of Surgery, Amita Health Saint Joseph's Hospital, Chicago, Illinois
,
Arshad A. Khan
4   Department of Orthopedic Surgery, Indiana University School of Medicine, Gary/Northwest, Indiana
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Abstract

Background A proximal deep peroneal nerve (DPN) injury can significantly impact the functional capacity of the leg, to include compromised motor function of the tibialis anterior (TA) muscle. Clinical examination can range from weakness in ankle dorsiflexion, to complete foot drop. Diagnostic nerve conduction velocity (NCV) testing can demonstrate abnormalities at select areas of impingement (or) entrapment (i.e., regions affected by a demyelinating compression mono-neuropathy), along the proximal course of the common peroneal nerve.

Methods We retrospectively report on 17 patients with clinical weakness involving ankle dorsiflexion. All patients underwent surgical end-to-side anastomosis, transferring a muscular nerve branch from the superficial peroneal nerve (SPN) to a segment of the DPN responsible for TA muscle innervation. Outcomes were based on comparisons of preoperative and postoperative DPN motor function to the TA muscle, standardized to the British Medical Research Council Scale for Muscle Strength. Preoperative scores were generally M2 or below.

Results Postoperative outcome scores of M4 to M5 were considered good (or) successful. 94.1% of patients demonstrated successful outcomes.

Conclusion An end-to-side SPN motor branch anastomosis, into the motor branch of the DPN responsible for TA muscle innervation, can be a viable treatment option for weakness in ankle dorsiflexion. All reported cases involved a compromised segment of deep peroneal nerve within the proximal one-third of the leg.

Keywords

weakness - ankle dorsiflexion - deep peroneal nerve

* The views expressed herein are those of the author(s) and do not reflect the official policy or position of the U.S. Army Medical Department, Department of the Army, Department of Defense, or the U.S. Government.




Publication History

Received: 10 May 2021

Accepted: 03 November 2021

Article published online:
18 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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