Transferring motor branches from proximal tibial nerve for treatment of high fibular nerve injuries: An anatomical study / 第二军医大学学报

ABSTRACT

Objective To observe the anatomy of proximal tibial nerve, so as to assess the feasibility of transferring motor branches from proximal tibial nerve for treatment of the high fibular nerve or long-segment injuries.Methods Totally 23 sides of lower limbs from 12 adult cadavers were included in the present study. The branching pattern, length, diameter of motor branches of the tibial nerve in the proximal leg, location of original point relative to fibular head level and the distance from original point to the fibular neck were examined. Intraneural dissection from the bifurcation of the common fibular nerve to the proximal (deep fibular nerve and superficial fibular nerve) was performed, and then the maximum dissected length and the diameter of deep fibular nerves were observed. The deep fibular nerve was severed at the top site and simulating transfer was performed; the feasibility of suturing the motor branches from proximal tibial nerve and the deep fibular nerve was assessed. Results There were three main motor branches at the proximal leg, including the branches to the lateral and medial head of the gastrocnemius and to the soleus muscle, with the length being (36.3±9.6) mm, (44.7±8.6) mm and (53.2±9.9) mm, respectively. The maximum length of intraneural dissection of the common fibular nerve was (59.3±7.2) mm. After dissection, the branches to the soleus muscle and the lateral head of the gastrocnemius were long enough for direct nerve suture with the deep fibular division in all cadavers without tension. The branches to the medial head of the gastrocnemius were long enough for nerve suture in 21 sides (91.3%). Conclusion After intraneural dissection of the common fibular nerve, the motor branches from proximal tibial nerve can be transferred to restore the deep fibular nerve for treating high fibular nerve injuries. The branch to the soleus muscle is the best choice considering its length and diameter.