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Publicado el 27/02/2014
Superficial Peroneal and Sural Neuroma Transposition in a Case of Neuropathic Pain Following Foot Surgery
Standard Edition (140220.120219)
Pain resulting from nerve injury can originate from the site of injury (local neuroma pain) and from the collateral sprouting of adjacent sensory territories into the deinnervated territory (hyperalgesic pain). Surgical management of neuropathic pain is controversial and typical management of neuroma pain includes excision and transposition. In our institution, management includes a proximal crush injury to facilitate an axonal injury and a period of prolonged regeneration, neuroma resection with distal end cautery cap, and proximal intermuscular transposition. In the case, the patient presented with severe neuropathic pain in the anterior/lateral region of the ankle and foot, following surgery to correct flat foot deformity. Two attempts to surgically resolve the neuropathic pain from a sural neuroma failed before being referred to our institution. Examination and provocative tests revealed involvement of the sural nerve and superficial peroneal nerve. Surgical management included exploration and transposition of the sural nerve and superficial peroneal nerve with releases of the peroneal nerve at the fibular head, lateral sural nerve, and deep peroneal nerve. The nerves releases were included due to having positive provocative tests during examination.
Table of Contents (Standard)
00:25 Pre-operative Examination and Management Discussion
01:53 Operative Positioning and Considerations
02:29 Superficial Peroneal Nerve Exploration -- Incision
03:19 Identifying and Releasing the Overlying Superficial Fascia
03:45 Identifying and Releasing the Transverse Crural Ligament
04:28 Proximal Exposure of the Superficial Peroneal Nerve
05:34 Peroneal Nerve Release at the Fibular Head -- Incision
07:20 Identifying the Common Peroneal Nerve
08:22 Identifying and Releasing the Posterior Crural Intermuscular Septum
09:44 Identifying the Lateral Sural Nerve
10:49 Sural Nerve Exploration - Incision
11:44 Exposing the Sural Neuroma and Proximal Exposure of the Sural Nerve
13:43 Proximal Crush of Sural Nerve and Superficial Peroneal nerve
14:04 Neuroma Resection, Cautery Cap, and Proximal Transposition of the Sural Nerve
15:40 Cautery Cap and Proximal Transposition of the Superficial Peroneal Nerve
16:28 Deep Peroneal Nerve Release -- Incision and Release
Narration: Susan E. Mackinnon
Videography: Andrew Yee
Terms of Use and Private Policy: nervesurgery.wustl.edu/pages/termsofuse.
Standard Edition (140220.120219)
Pain resulting from nerve injury can originate from the site of injury (local neuroma pain) and from the collateral sprouting of adjacent sensory territories into the deinnervated territory (hyperalgesic pain). Surgical management of neuropathic pain is controversial and typical management of neuroma pain includes excision and transposition. In our institution, management includes a proximal crush injury to facilitate an axonal injury and a period of prolonged regeneration, neuroma resection with distal end cautery cap, and proximal intermuscular transposition. In the case, the patient presented with severe neuropathic pain in the anterior/lateral region of the ankle and foot, following surgery to correct flat foot deformity. Two attempts to surgically resolve the neuropathic pain from a sural neuroma failed before being referred to our institution. Examination and provocative tests revealed involvement of the sural nerve and superficial peroneal nerve. Surgical management included exploration and transposition of the sural nerve and superficial peroneal nerve with releases of the peroneal nerve at the fibular head, lateral sural nerve, and deep peroneal nerve. The nerves releases were included due to having positive provocative tests during examination.
Table of Contents (Standard)
00:25 Pre-operative Examination and Management Discussion
01:53 Operative Positioning and Considerations
02:29 Superficial Peroneal Nerve Exploration -- Incision
03:19 Identifying and Releasing the Overlying Superficial Fascia
03:45 Identifying and Releasing the Transverse Crural Ligament
04:28 Proximal Exposure of the Superficial Peroneal Nerve
05:34 Peroneal Nerve Release at the Fibular Head -- Incision
07:20 Identifying the Common Peroneal Nerve
08:22 Identifying and Releasing the Posterior Crural Intermuscular Septum
09:44 Identifying the Lateral Sural Nerve
10:49 Sural Nerve Exploration - Incision
11:44 Exposing the Sural Neuroma and Proximal Exposure of the Sural Nerve
13:43 Proximal Crush of Sural Nerve and Superficial Peroneal nerve
14:04 Neuroma Resection, Cautery Cap, and Proximal Transposition of the Sural Nerve
15:40 Cautery Cap and Proximal Transposition of the Superficial Peroneal Nerve
16:28 Deep Peroneal Nerve Release -- Incision and Release
Narration: Susan E. Mackinnon
Videography: Andrew Yee
Terms of Use and Private Policy: nervesurgery.wustl.edu/pages/termsofuse.
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