Abstract:

Objective    To explore the feasibility of transfer of motor branches from the proximal tibial nerve to treat high-level sciatic nerve injuries in an anatomical study.   Methods    30 sides of lower limbs from 15 embalmed adult cadavers were used to dissect and the motor branches from proximal tibial nerve were measured for following parameters, such as length, diameter, the location of original point relative to the level of the fibular head and the distance from original point to the fibular neck. Intraneural dissection the common peroneous nerve from the bifurcation to the proximal was performed to isolate the division of the deep and superficial peroneous division; the maximum length of intraneural dissection that could be dissected and the diameter of deep peroneous nerves were also measured.  Results   There were three main motor branches at the proximal leg: the branches destined to the lateral and medial heads of the gastrocnemius and to the soleus muscle. The length of these branches was (36.3±9.6) mm, (44.7±8.6) and (53.2±9.9)mm  respectively. The maximum length of intraneural dissection of the common peroneous nerve was (59.3±7.2) mm. After dissection, branches to the soleus muscle and the lateral head of the gastrocnemius were adequate for direct nerve suture with the deep peroneous division in all cadavers without tension. And in 28 sides  of lower limbs (93.3 percent), branches to the medial head of the gastrocnemius were adequate for nerve suture.  Conclusion     After intraneural dissection of the common fibular nerve, the motor branches from the proximal part of the tibial nerve can be harvested and transfered to restore the deep peroneous nerve in the treatment of high sciatic nerve injuries. Considering the length and diameter, branches to the soleus muscle were the best choice for the proposed transfer.

Key words: High-levelsciatic nerve injury, Nerve transfer, Tibial nerve, Common peroneous nerve, Applied anatomy