Peripheral Nerve Injury to the Lower Limb: Repair and Secondary Reconstruction

Thatte, Mukund; Hiremath, Amita; Goklani, Mayur Sureshlal; Patel, Neehar; Takwale, Anupam B.

doi:10.1055/s-0039-1687921

Cited by 8 publications

(4 citation statements)

References 15 publications

(14 reference statements)

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“…In UE nerve transfers are favored over other methods of nerve reconstruction i.e. nerve autograft, as it can avoid harvesting a nerve graft and provide an optimal chance of functional recovery [ 26 ]. Furthermore, studies have shown similar if not better results from nerve transfer compared to that of long nerve grafts.…”

Section: Reviewmentioning

confidence: 99%

Management of Tourniquet-Related Nerve Injury (TRNI): A Systematic Review

Chang¹,

Bhandari²,

Messana³

et al. 2022

Cureus

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Tourniquet-related nerve injuries (TRNIs) are a rare but feared complication of operative tourniquet use. While the literature contains multiple discussions regarding tourniquet use as well as reported cases of its complications, there does not exist a consensus guideline for a safe tourniquet pressure, application time, or management of TRNI. This paper conducts a comprehensive review of the available literature for cases of TRNI with a specific focus on analyzing the management of cases of TRNI and their functional recovery. One hundred nine articles were retrieved in a search of medical literature (PubMed) using the keywords: tourniquet, nerve injury, paralysis, and palsy. The initial search was further narrowed down to seven case series and 10 case reports totaling 203 reported cases of TRNI. Of the 203 cases, 64 cases involved upper extremity tourniquet use, and 139 cases involved lower extremity tourniquet use. Most patients (89.75%) experienced a complete recovery. TRNI may occur over a wide range of tourniquet application times and tourniquet pressures; hence, it is a necessity for surgeons to consider it as a potential complication and understand the methodology for diagnosis and long-term management.

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Section: Reviewmentioning

confidence: 99%

Management of Tourniquet-Related Nerve Injury (TRNI): A Systematic Review

Chang¹,

Bhandari²,

Messana³

et al. 2022

Cureus

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“…TMR has been established as a viable surgical option in the prevention and management of neuroma pain in both amputee and nonamputee patients. 6 , 13 By rerouting the sensory nerve endings to motor nerves in a nearby muscle, TMR directs nerve regeneration into the target muscle, which results in decreased neuroma formation and effectively alleviates residual limb pain and phantom pain in amputees. 5 , 6 This decreased pain corresponds with concomitant decreased rates of narcotic use.…”

Section: Discussionmentioning

confidence: 99%

Management of Superficial and Deep Peroneal Nerve Neuromas with Targeted Muscle Reinnervation in Nonamputees: Operative Technique and Early Outcomes

Moradian,

Taritsa,

Sharma

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Targeted muscle reinnervation (TMR), a surgical technique developed by the senior authors that coapts proximal ends of nerves to distal motor nerves of adjacent muscles, has demonstrated efficacy in the treatment and prevention of neuroma pain. The objective of this study is to describe the surgical technique for TMR of the superficial peroneal nerve (SPN) and deep peroneal nerve (DPN) in nonamputee patients and provide data on postoperative functional outcomes. Methods: A single-institution retrospective chart review was performed between March 2018 and April 2021. Patients were de-identified and included if they were nonamputees receiving TMR for pain in the peroneal nerve distribution. Data extracted included demographic information, symptoms before operation, relevant nerve coaptation, peri-, and postoperative complications, and long-term functional outcomes. Results: Of the 19 patients reviewed, 11 patients underwent TMR of the SPN alone: eight had complete resolution of their symptoms; two indicated partial improvement in pain; and one patient had no improvement. Four patients underwent TMR of the DPN alone: two patients had complete resolution of their pain, and two patients had partial improvement with pain. Four patients underwent TMR of both the SPN/DPN: two patients had complete resolution of their symptoms, and two patients were noted to have significant improvement but had persistent pain from prior foot operations. Average follow-up time was 260 days. Conclusions: TMR is a successful technique in the management of SPN and DPN neuroma pain. Our technique revealed excellent clinical outcomes, no procedure-specific complications, and improved subjective pain reports.

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“…Sciatic nerve injury (SNI) has the characteristics of high disability rate and di cult recovery of nerve function [1], and secondary lesions will spread to the surrounding normal tissues, resulting in chronic loss of function [2]. The etiology of secondary damage in SNI is not yet clear, but microcirculation disturbance is considered to be one of the important reasons for secondary damage [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Effect and mechanism of Tetramethylpyrazine in repair of sciatic nerve injury in rats

Li,

Wang

et al. 2024

Preprint

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Objective: Observing the effects of Tetramethylpyrazine (TMP) on the expression of Collagen IV and Laminin in neurovascular basement membrane and the apoptosis of vascular endothelial cells, and to study the mechanism of TMP in the treatment of sciatic nerve injury. Methods: Sprague Dawley (SD) rats were randomly divided into control group, the model of sciatic nerve crush injury was made by means of hemostatic forceps, These rats were randomly divided into sham operation group (NC group), Tetramethylpyrazine group (TMP group, 200mg/kg), and normal saline group (NS group, 200mg/kg). Sciatic nerve function index (SFI) and grid crawling experiments were used for behavioral evaluation. hematoxylin-eosin (HE) staining was performed to observe its pathological structure and morphology. Immunohistochemistry was used to assess the expression level of Collagen IV and Laminin expression in sciatic nerve vascular basal membrane. Immunofluorescence was used to detect the expression of CD31 and Brdu receptors. The number of Circulating endothelial cells (CECs) was detected by flow cytometry. Results：Compared with the NS group, the TMP group had a significant increase in the sciatic nerve function index (P<0.01).The miss times in TMP group was significantly lower than that in NS group (P<0.01). The HE staining results of the TMP group showed irregular arrangement of some neuronal axons and Schwann cells, and more edema and rupture of cells. The proliferation of glial cells and inflammatory cells was significantly increased in TMP group. The results of immunohistochemistry showed that the expression of type IV collagen and laminin in the TMP group group was distributed around the blood vessels, vascular endothelial cells, basal membrane and glial cells after SNI. The expression of type IV collagen and laminin in TMP group increased significantly(P< 0.05). Immunofluorescence showed that compared with NS group, the apoptosis rate of TMP group was significantly decreased (P< 0.01). Flow cytometry results showed that compared with the NS group, the number of CECs in the TMP group was significantly decreased (P< 0.01).

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Peripheral Nerve Injury to the Lower Limb: Repair and Secondary Reconstruction

Cited by 8 publications

References 15 publications

Management of Tourniquet-Related Nerve Injury (TRNI): A Systematic Review

Management of Tourniquet-Related Nerve Injury (TRNI): A Systematic Review

Management of Superficial and Deep Peroneal Nerve Neuromas with Targeted Muscle Reinnervation in Nonamputees: Operative Technique and Early Outcomes

Effect and mechanism of Tetramethylpyrazine in repair of sciatic nerve injury in rats

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