Division of Craniofacial and Plastic Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington, USA.
Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA.
Microsurgery. 2022 Jan;42(1):71-75. doi: 10.1002/micr.30650. Epub 2020 Sep 22.
Peroneal nerve palsy with resultant foot drop has significant impacts on gait and quality of life. Traditional management includes ankle-foot-orthosis, tendon transfer, and arthrodesis-each with certain disadvantages. While nerve transfers for peroneal nerve injury have been reported in adults, with variable results, they have not been described in the pediatric population. We report the use of partial tibial nerve transfer for foot drop from deep peroneal nerve palsy in three pediatric patients. The first sustained a partial common peroneal nerve laceration and underwent transfer of a single tibial nerve branch to deep peroneal nerve 7 months after injury. Robust extensor hallucis longus and extensor digitorum longus reinnervation was obtained without satisfactory tibialis anterior function. The next patient sustained a thigh laceration with partial sciatic nerve injury and underwent transfer of two tibial nerve branches directly to the tibialis anterior component of deep peroneal nerve 9 months after injury. The final patient sustained a blast injury to the posterior knee and similarly underwent a double fascicular transfer directly to tibialis anterior 4 months after injury. The latter two patients obtained sufficient strength (MRC 4-5) at 1 year to discontinue orthosis. In all patients, we used flexor hallucis longus and/or flexor digitorum longus branches as donors without postoperative loss of toe flexion. Overall, our experience suggests that early double fascicular transfer to an isolated tibialis anterior target, combined with decompression, could produce robust innervation. Further study and collaboration are needed to devise new ways to treat lower extremity nerve palsies.
腓总神经麻痹导致足下垂，对步态和生活质量有重大影响。传统的治疗方法包括踝足矫形器、肌腱转移和关节融合术，每种方法都有一定的缺点。虽然已经有报道称成人腓总神经损伤可以进行神经转移，但结果不一，而在儿科人群中尚未有描述。我们报告了在 3 名儿科患者中使用部分胫神经转移治疗腓深神经麻痹导致的足下垂。第一例患者发生部分腓总神经割裂伤，在损伤后 7 个月接受单一胫神经分支转移到腓深神经；获得了强大的伸踇长肌和伸趾长肌神经再支配，但胫骨前肌功能不满意。第二例患者发生大腿割裂伤伴部分坐骨神经损伤，在损伤后 9 个月接受两条胫神经分支直接转移到腓深神经的胫骨前肌成分。最后一例患者的膝关节后侧受到爆炸伤，同样在损伤后 4 个月接受双束支直接转移到胫骨前肌。后两名患者在 1 年内获得足够的力量（MRC 4-5）以停用矫形器。在所有患者中，我们使用踇长屈肌和/或趾长屈肌分支作为供体，术后没有出现脚趾弯曲丧失。总体而言，我们的经验表明，早期对孤立的胫骨前肌目标进行双束支转移，结合减压术，可产生强大的神经支配。需要进一步的研究和合作来设计治疗下肢神经麻痹的新方法。
