Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 751 85 Uppsala, Sweden.
J Plast Reconstr Aesthet Surg. 2011 Nov;64(11):1512-6. doi: 10.1016/j.bjps.2011.05.027. Epub 2011 Jun 23.
Nerve reconstruction following lower-extremity nerve injuries usually leads to worse outcomes in comparison with upper-extremity injuries due to the long distances of nerve regeneration. This study was performed to consider the clinical application of distal nerve transfer for the treatment of long gaps of the tibial nerve (TN) and in established compartment syndrome. It aimed to determine the anatomic suitability of transferring the sural nerve (SN) in combination with the superficial peroneal nerve (SPN) to the TN at the level of the tarsal tunnel for restoration of plantar sensation.
Nine fresh above-knee amputated limbs were dissected with the aid of loupe magnification. We focussed on the detailed anatomy of the course of the SN and the SPN from its emergence proximally at the knee level to the foot. Two different regions, suprafascial and subfascial, were described for each nerve. The maximum length of dissection and the length of the nerves in each region were measured. In all dissections, we assessed the feasibility of directly transferring the SN and SPN to the TN at the level of the tarsal tunnel.
The average length of the course of the SN was 20.6 cm (SD ± 2.3 cm) subfascially and 16.4 cm (SD ± 0.9 cm) suprafascially. For the SPN, the average length was 19.4 cm (SD ± 1.9 cm) subfascially and 18 cm (SD ± 2.5 cm) suprafascially. The point of emergence of the nerve from the subfascial course to the suprafascial course was defined as the pivot point for its transfer to the TN. Both the SN and the SPN reached the TN comfortably at the level of the tarsal tunnel, allowing direct co-aptation.
Distal nerve transfer using the SN in combination with the SPN is an anatomically reliable procedure, being a potential alternative to the use of nerve grafts in reconstruction of long gaps of the TN. In addition, selected patients with compartment syndrome may also benefit from this transfer to restore plantar sensation.
下肢神经损伤后的神经重建通常比上肢损伤的结果更差，因为神经再生的距离较长。本研究旨在考虑使用远端神经转移治疗胫骨神经（TN）的长间隙和已建立的间隔综合征。目的是确定将腓肠神经（SN）与腓浅神经（SPN）结合转移到跗管内 TN 以恢复足底感觉的解剖学适宜性。
在放大镜的辅助下解剖了 9 个以上膝截肢肢体。我们专注于 SN 和 SPN 从膝关节近端到足部的行程的详细解剖。为每个神经描述了两个不同的区域，即筋膜上和筋膜下。测量了最长的解剖长度和每个区域的神经长度。在所有解剖中，我们评估了直接将 SN 和 SPN 转移到 TN 在跗管水平的可行性。
SN 的筋膜下平均行程长度为 20.6 厘米（SD ± 2.3 厘米），筋膜上为 16.4 厘米（SD ± 0.9 厘米）。对于 SPN，平均长度为 19.4 厘米（SD ± 1.9 厘米）筋膜下和 18 厘米（SD ± 2.5 厘米）筋膜上。神经从筋膜下行程向筋膜上行程转移的出线点被定义为其转移到 TN 的枢轴点。SN 和 SPN 都舒适地到达 TN 在跗管水平，允许直接吻合。
使用 SN 结合 SPN 的远端神经转移是一种解剖学上可靠的方法，是重建 TN 长间隙的神经移植物的潜在替代方法。此外，选择的间隔综合征患者也可能受益于这种转移来恢复足底感觉。
