title: Surgical treatment of traumatic peroneal nerve lesions.
abstract: OBJECTIVE
  In this study, we compare different surgical procedures regarding the functional outcome of traumatic peroneal nerve lesions.
  
  
  METHODS
  In a retrospective study, 48 patients with traumatic lesions (17 iatrogenic) of the peroneal nerve were evaluated. Twenty-two patients presented with lesions in continuity displaying regenerative potential by nerve action potential recording. In these cases, surgery was restricted to either external (12/) or interfascicular neurolysis (10/). Twenty-two cases had no regenerative potential (10/) or showed discontinuity (12/) and thus were reconstructed with autologous sural nerve grafts. In four cases, a reconstructive procedure was intraoperatively abandoned as a result of the large extent of the lesion.
  
  
  RESULTS
  Thirty-six patients with an adequate follow-up period of at least 18 months were included in this study. Among those with external neurolysis, 73% (eight out of 11) showed a good functional outcome, obviating the need for a kick-up foot brace (M >or= 4). In the interfascicular neurolysis group, 71% (five out of seven) exhibited a similar outcome. In the grafted group, however, only 28% (five out of 18) obtained a functionally useful result dependent on graft length. A graft length under 6 cm led to a functionally useful outcome in 44% of patients (four out of nine) compared with 11% (one out of nine) when the graft length was greater than or equal to 6 cm. In six patients, muscle-tendon transfers were performed, resulting in strong, useful foot lift.
  
  
  CONCLUSIONS
  Peroneal nerve lesions lacking regenerative signs should be explored. A functionally useful result (M >or=4) was achieved in 72% of the patients with either external or internal neurolysis and in 28% of the patients after a nerve graft procedure. Patients in whom nerve surgery failed to reconstitute useful foot lift need to be evaluated for their suitability to undergo a tendon transfer procedure.
authors.affiliation: Department of Neurosurgery, University of Ulm, Guenzburg, Germany. julia.seidel@uni-ulm.de
authors.forename: Julia A
authors.initials: JA
authors.lastname: Seidel
authors.forename: Ralph
authors.initials: R
authors.lastname: Koenig
authors.forename: Gregor
authors.initials: G
authors.lastname: Antoniadis
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Richter
authors.forename: Thomas
authors.initials: T
authors.lastname: Kretschmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010543:Peroneal Nerve / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*