title: Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique.
abstract: BACKGROUND
  Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion.
  
  
  METHODS
  The transposition of the lateral head of the gastrocnemius muscle to the tendons of the anterior tibial muscle group, with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy is performed in one stage. It includes 10 key steps which are described in this article. Since 1994, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We review the indications and limitations of the technique.
  
  
  CONCLUSIONS
  Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction.
authors.affiliation: Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland. Electronic address: franckleclere@yahoo.fr.
authors.forename: F M
authors.initials: FM
authors.lastname: Leclère
authors.affiliation: Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Badur
authors.affiliation: Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Mathys
authors.affiliation: Department of Plastic Surgery, Hand Surgery & Peripheral Nerve Surgery, INSELSPITAL Bern, University of Bern, 3008 Freiburgstrasse, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Vögelin
mesh_terms: D006801:Humans; D018482:Muscle, Skeletal / Q000601:surgery*; D016067:Nerve Transfer / Q000379:methods; D010543:Peroneal Nerve / Q000601:surgery*; D020427:Peroneal Neuropathies / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013709:Tendon Transfer / Q000379:methods
keywords: Flexion dorsale active du pied; Foot drop; Gastrocnemius muscle transfer; Lower limb; Lésion nerveuse; Membre inférieur; Nerf fibulaire; Nerf sciatique poplité externe; Nerve injury; Nerve transfer; Neurotisation; Neurotization; Peroneal nerve; Pied ballant; Transfert de muscle jumeau