Mosa Adam J, Randall Zachary D, Navarro Brendan J, Hunter Daniel A, Brogan David M, Dy Christopher J
From the Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Plast Reconstr Surg Glob Open. 2025 May 9;13(5):e6781. doi: 10.1097/GOX.0000000000006781. eCollection 2025 May.
Foot drop carries substantial morbidity and is often due to deep peroneal (DPN) or common peroneal nerve (CPN) injury. Treatment options are limited. This study explored a new surgical approach by transferring a superficial peroneal nerve (SPN) branch to DPN. Cadaveric analysis, manual histomorphometry, and a case report are presented.
Twenty-one limbs were analyzed. A reproducible surgical approach was used to identify CPN and trace it to the bifurcation into SPN and DPN, and then to the insertions into the peroneus longus (PL) and tibialis anterior (TA) muscles, respectively. Measurements were made from the superior most aspect of the fibular head to the bifurcation of the CPN, the insertion of the first and second SPN motor branches to the PL, and to the insertion of the DPN into the TA. The first SPN motor branch to the PL and DPN into the TA nerves were harvested, and histomorphological measurements of axonal densities were obtained.
Histomorphological analysis showed similar axonal densities between the transferred and target nerves, indicating a comparable potential for effective reinnervation. The mean distances from fibular head to various nerve branches were recorded to ensure tension-free transfer. No significant differences were found between nerve groups regarding axon density, total fascicle area, or total axon counts.
This study supported feasibility of this nerve transfer technique, with initial results suggesting it represents a viable treatment option for foot drop secondary to DPN injury. Further research is needed to confirm these findings.
足下垂会导致严重的发病率，且通常是由腓深神经（DPN）或腓总神经（CPN）损伤引起的。治疗选择有限。本研究探索了一种通过将腓浅神经（SPN）分支转移至DPN的新手术方法。文中呈现了尸体分析、手动组织形态计量学研究及病例报告。
对21条肢体进行了分析。采用一种可重复的手术方法来识别CPN，并追踪其至分叉为SPN和DPN处，然后分别追踪至其在腓骨长肌（PL）和胫骨前肌（TA）的附着点。测量了从腓骨头最上方至CPN分叉处、第一和第二SPN运动分支至PL的附着点以及DPN至TA的附着点的距离。采集了至PL的第一SPN运动分支和至TA的DPN神经，并获得了轴突密度的组织形态学测量结果。
组织形态学分析显示，转移神经和目标神经之间的轴突密度相似，表明有效再支配的潜力相当。记录了从腓骨头到各神经分支的平均距离，以确保无张力转移。在神经组之间，关于轴突密度、总束面积或总轴突数量未发现显著差异。
本研究支持了这种神经转移技术的可行性，初步结果表明它是DPN损伤继发足下垂的一种可行治疗选择。需要进一步研究来证实这些发现。
