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Clinics in Sports Medicine Oct 2020Common peroneal nerve dysfunction after a multiligament knee injury can be devastating. In patients with persistent foot drop, posterior tibial tendon transfer to the... (Review)
Review
Common peroneal nerve dysfunction after a multiligament knee injury can be devastating. In patients with persistent foot drop, posterior tibial tendon transfer to the dorsum of the foot is a reliable and safe procedure to restore dorsiflexion. These authors favor passing the posterior tibial tendon through the interosseous membrane and docking it into the lateral/middle cuneiforms. A Strayer procedure or tendo-Achilles lengthening must be performed in patients unable to achieve at least 10° of passive dorsiflexion. Despite the operative limb having 30% to 40% of ankle dorsiflexion strength of the uninjured limb, short- and long-term functional outcomes are excellent.
Topics: Humans; Knee Injuries; Peripheral Nerve Injuries; Peroneal Nerve; Tendon Transfer; Treatment Outcome
PubMed: 32892969
DOI: 10.1016/j.csm.2020.07.003 -
Journal of Plastic, Reconstructive &... Jul 2021Several different flaps can reconstruct intraoral defects or lower limb deficits after free fibula osteo-cutaneous flap harvesting for jaw reconstructions. However,...
BACKGROUND
Several different flaps can reconstruct intraoral defects or lower limb deficits after free fibula osteo-cutaneous flap harvesting for jaw reconstructions. However, commonly used options may not be available for various reasons and can be associated with significant morbidity. We hypothesized that flaps supplied by the superficial peroneal nerve accessory artery (SPNAA) could be a viable alternative reconstructive option.
METHODS
We describe the SPNAA's anatomy using 20 human cadaveric leg dissections and report eight cases involving SPNAA-based perforator flap reconstructions (six propeller flaps and two free flaps) in a retrospective case series. Patient-specific baseline variables and intraoperative and postoperative outcomes are described.
RESULTS
Cadaveric dissection suggests that the location of the SPNAA is reliable but its origin varies, with 40% (N = 8) of SPNAAs being of type I origin, 20% type II (N = 4), and 40% (N = 8) type III in our series. All reconstructions were successful. No intraoperative complications occurred during propeller or free-flap reconstructions. No flap failures occurred. One propeller reconstruction showed distal superficial skin necrosis and one donor site wound dehisced; both were successfully managed conservatively. No other short-term or long-term complications occurred.
CONCLUSIONS
Flaps based on SPNAA perforators appear effective, reliable, and safe reconstructive methods for covering fibula osteocutaneous donor site defects and for intraoral reconstructions. Controlled trials are required to compare its effectiveness and safety with other reconstructive methods.
Topics: Aged; Cadaver; Female; Fibula; Head and Neck Neoplasms; Humans; Male; Mandibular Reconstruction; Middle Aged; Perforator Flap; Peroneal Nerve; Plastic Surgery Procedures; Retrospective Studies
PubMed: 33288472
DOI: 10.1016/j.bjps.2020.11.012 -
The International Journal of... Mar 2021Restless legs syndrome (RLS) is a condition that particularly urges at night in resting and causes the need to move the legs. Although the pathophysiology has not yet...
Restless legs syndrome (RLS) is a condition that particularly urges at night in resting and causes the need to move the legs. Although the pathophysiology has not yet been clarified, dopamine and iron metabolism and spinal cord pathologies are blamed for causing the condition. There are few studies on spinal reflex mechanisms on RLS. In the present study, we aimed to investigate the role of presynaptic inhibition (PreI) in the spinal cord in RLS. Fourteen patients with RLS and 14 controls with similar demographic characteristics were included in the study. Soleus muscle H-reflex (Ht) investigation was performed for subjects whose electrophysiologic investigation was normal. The Ht response was conditioned to the stimulation of the common peroneal nerve (CPN) (Hc). The test and conditioned stimulation intervals were kept between 10 ms, 20 ms, 30 ms, 40 ms, 50 ms, 75 ms, 100 ms, 150 ms and 200 ms. In each inter-stimulus interval, nonparametric repeat measurement evaluations were conducted with the percentage value of Hc/Ht. The Hc/Ht values of the study and control groups in the same intervals were compared separately. A significant decrease was detected in Hc values in the control group in the repeat measurement values at 20 ms and 100 ms inter-stimulus intervals; however, there was not decrease in any intervals in the patient's group. The absence of any decrease in Hc reflexes for 20-100 ms intervals revealed that discernible PreI was vanished in RLS patients.
Topics: Adult; Electric Stimulation; Electromyography; Female; H-Reflex; Humans; Male; Middle Aged; Muscle, Skeletal; Neural Inhibition; Peroneal Nerve; Presynaptic Terminals; Restless Legs Syndrome
PubMed: 32108535
DOI: 10.1080/00207454.2020.1737048 -
Heliyon Sep 2021The main nerves in the knee region are the tibial nerve, the common peroneal nerve, and the saphenous nerve. These three nerves innervate the lower leg and foot,... (Review)
Review
The main nerves in the knee region are the tibial nerve, the common peroneal nerve, and the saphenous nerve. These three nerves innervate the lower leg and foot, providing sensory and motor function. The large sciatic nerve splits just above the knee to form the tibial and common peroneal nerves. The tibial nerve travels down in the posterior region, while the common peroneal nerve runs around the lateral side of the knee and runs down the front of the leg to the foot. Although all these nerves can be affected by injuries of the knee, the infrapatellar branch of the saphenous nerve (IPBSN) and the common peroneal nerve (CPN) are most affected. In this narrative review we focus on neuropathies associated with nerves located in the region of the knee joint in the context of their injuries and possible iatrogenic damage during reconstructive surgery.
PubMed: 34611563
DOI: 10.1016/j.heliyon.2021.e08032 -
Acta Cirurgica Brasileira 2021To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation...
PURPOSE
To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation in acute trauma.
METHODS
140 animals were randomly divided in seven groups: control, denervated, end-to-side neurorrhaphy between distal stump of common peroneal nerve and tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and platelet gel within stem cells (without culture) removed from the adipose tissue. Mass measurements of the animal and of cranial tibial muscles, electromyography, walking track analysis tests and histological examinations of the nerves and muscles after 180 days was performed.
RESULTS
In the groups where the ESN was performed, the results were always better when compared to the denervated group, showing reinnervation in all ESN groups. The most sensitive methods were walking track and histological analysis. Only the group with stem cells showed values similar to the control group, as well as the functional indices of peroneal nerve and the number of nerve fibers in the peroneal nerve.
CONCLUSIONS
Stem cells were effective in ESN according with the functional index of the peroneal nerve, evaluated by walking track analysis and the number of nerve fibers in the peroneal nerve.
Topics: Animals; Muscle, Skeletal; Nerve Regeneration; Neurosurgical Procedures; Peroneal Nerve; Rats; Stem Cells; Tibial Nerve
PubMed: 33503220
DOI: 10.1590/ACB351207 -
Surgical and Radiologic Anatomy : SRA Apr 2022Superficial fibular nerve (SFN) and sural nerve are at risk during osteosynthesis of the lateral malleolus. The aim of this anatomical study was to describe the...
PURPOSE
Superficial fibular nerve (SFN) and sural nerve are at risk during osteosynthesis of the lateral malleolus. The aim of this anatomical study was to describe the relationships of the superficial fibular and sural nerves with respect to the lateral malleolus.
METHODS
Nine corpses (18 ankles) were dissected, using a direct lateral approach. Measurements were recorded between the fibula and the nerves, and the pattern variations of the SFN were recorded for both right and left side to assess intra-individual variability.
RESULTS
Distance between the tip of the lateral malleolus and the piercing of fascia cruris was 111 ± 26 mm for type 1 pattern, and range was 46-161 mm all types included. 78% (14 SFN) were type 1 pattern, 17% (3 SFN) were type 2 pattern, and 5% (1 SFN) were type 3 pattern. 44% (4 specimen) had a type 1 pattern SFN on one ankle and another pattern on the other ankle. The sural nerve was always observed just posterior to the lateral malleolus.
CONCLUSION
This study demonstrated a great inter-individual variability especially for the SFN, but also an intra-individual variability with frequent different patterns between right and left leg. It is important to know the anatomical variations of the SFN and sural nerve to decrease the risk of intra operative nerve injury during direct lateral approach of lateral malleolus.
Topics: Ankle; Cadaver; Fibula; Humans; Peroneal Nerve; Sural Nerve; Surgeons
PubMed: 35243546
DOI: 10.1007/s00276-022-02909-8 -
Quantitative Imaging in Medicine and... Jan 2022To evaluate the diagnostic accuracy of diffusion tensor imaging (DTI) in diabetic peripheral neuropathy (DPN) for patients with type 2 diabetes and detect the...
BACKGROUND
To evaluate the diagnostic accuracy of diffusion tensor imaging (DTI) in diabetic peripheral neuropathy (DPN) for patients with type 2 diabetes and detect the correlations with electrophysiology.
METHODS
A total of 27 patients with type 2 diabetes with DPN, 24 patients with type 2 diabetes without peripheral neuropathy (NDPN), as well as 32 healthy controls (HC) were enrolled in this study. Clinical examinations and neurophysiologic tests were used to determine the presence of DPN. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of peripheral nerves, including the tibial nerve (TN) and common peroneal nerve (CPN), were calculated. Receiver operating characteristic (ROC) analysis was performed for FA and ADC values. Pearson's correlation coefficient was used to assess the correlation between DTI and electrophysiology parameters in the patient group.
RESULTS
The tibial and common peroneal nerve FAs were lowest (P=0.003, 0.001, respectively) and ADC was highest (P=0.004, 0.005, respectively) in the DPN group. The FA value of the axonal injury group was lower than that in the demyelination group (P=0.035, 0.01, respectively), while the ADC value was higher (P=0.02, 0.01, respectively). In the DPN group, FA value was positively correlated with motor conduction velocity (MCV) (tibial nerve: r=0.420, P=0.007; common peroneal nerve: r=0.581, P<0.001) and motor amplitude (MA) (tibial nerve: r=0.623, P<0.001; common peroneal nerve: r=0.513; P=0.001), while ADC values was negatively correlated with MCV (tibial nerve: r=-0.320, P=0.044; common peroneal nerve: r=-0.569; P<0.001), and MA (tibial nerve: r=-0.491, P=0.001; common peroneal nerve: r=-0.524; P=0.001).
CONCLUSIONS
With a lower FA value and higher ADC value, DTI accurately discriminated DPN. The DTI multi-parameter quantitative analysis of peripheral nerves differentiated DPN axonal injury from the demyelinating lesion, and hence, could be applied in the diagnosis of DPN.
PubMed: 34993088
DOI: 10.21037/qims-21-126 -
Morphologie : Bulletin de L'Association... Sep 2021Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical...
OBJECTIVE OF THE STUDY
Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical description of the SPN.
MATERIALS AND METHODS
Twenty-three embalmed cadaver lower limbs were dissected.
RESULTS
The SPN emerged from the crural fascia about 6.3±7.7mm anteromedial to the anterior border of the fibula and 26.8±12.6mm anteromedial and 113.6±43.9mm superior to the tip of the lateral malleolus. The median point of bifurcation into two terminal branches was 13.0mm anteromedial to the anterior border of the fibula and 34.9±14.7mm anteromedial and 81.0±69.0mm superior to the tip of the lateral malleolus. The SPN was found between 5.76% and 7.70% of the individual's height proximal to the tip of the lateral malleolus, with an unpredictable branching pattern over the intermalleolar line.
CONCLUSION
A lateral ankle approach over the posterolateral surface of the fibula (posterior to the tip of the lateral malleolus) minimizes the risk of iatrogenic nerve lesion.
Topics: Cadaver; Humans; Iatrogenic Disease; Lower Extremity; Peroneal Nerve
PubMed: 33642180
DOI: 10.1016/j.morpho.2020.09.004 -
BMC Neuroscience Oct 2021Sensory input via neuromuscular electrical stimulation (NMES) may contribute to synchronization between motor cortex and spinal motor neurons and motor performance...
BACKGROUND
Sensory input via neuromuscular electrical stimulation (NMES) may contribute to synchronization between motor cortex and spinal motor neurons and motor performance improvement in healthy adults and stroke patients. However, the optimal NMES parameters used to enhance physiological activity and motor performance remain unclear. In this study, we focused on sensory feedback induced by a beta-band frequency NMES (β-NMES) based on corticomuscular coherence (CMC) and investigated the effects of β-NMES on CMC and steady-state of isometric ankle dorsiflexion in healthy volunteers. Twenty-four participants received β-NMES at the peak beta-band CMC or fixed NMES (f-NMES) at 100 Hz on different days. NMES was applied to the right part of the common peroneal nerve for 20 min. The stimulation intensity was 95% of the motor threshold with a pulse width of 1 ms. The beta-band CMC and the coefficient of variation of force (Force CV) were assessed during isometric ankle dorsiflexion for 2 min. In the complementary experiment, we applied β-NMES to 14 participants and assessed beta-band CMC and motor evoked potentials (MEPs) with transcranial magnetic stimulation.
RESULTS
No significant changes in the means of beta-band CMC, Force CV, and MEPs were observed before and after NMES conditions. Changes in beta-band CMC were correlated to (a) changes in Force CV immediately, at 10 min, and at 20 min after β-NMES (all cases, p < 0.05) and (b) changes in MEPs immediately after β-NMES (p = 0.01). No correlations were found after f-NMES.
CONCLUSIONS
Our results suggest that the sensory input via NMES was inadequate to change the beta-band CMC, corticospinal excitability, and voluntary motor output. Whereas, the β-NMES affects the relationship between changes in beta-band CMC, Force CV, and MEPs. These findings may provide the information to develop NMES parameters for neurorehabilitation in patients with motor dysfunction.
Topics: Adult; Electric Stimulation; Evoked Potentials, Motor; Female; Humans; Isometric Contraction; Male; Motor Cortex; Muscle Contraction; Muscle, Skeletal; Peroneal Nerve; Pyramidal Tracts; Transcranial Magnetic Stimulation; Young Adult
PubMed: 34645385
DOI: 10.1186/s12868-021-00665-w -
Journal of Clinical Anesthesia May 2020
Topics: Humans; Paralysis; Peroneal Nerve; Peroneal Neuropathies; Shoulder
PubMed: 31784305
DOI: 10.1016/j.jclinane.2019.109660