Surgical treatment of injuries of nervus fibularis

In this retrospective study, we present the results of 40 surgeries of 40 patients that within the period of 15 years, i.e. from 1985 to 1999 were provided the treatment of 40 lesions of n. fibularis, historically treated as problematic in terms of successful healing. The work provides the fundamental lines of their surgery treatment.

From the total number of 40, external neurolysis was performed to 20 patients. The remaining 20 patients were provided with reconstruction surgeries of the injured nerves, while 8 surgeries was done by suture of peripheral nerve and 12 surgeries were performed by nerve graft, in cases of complete and persisting neurological deficit and absence of action potential at EMG. The mechanism of lesion included the damages of nerve from elongation, with or without fracture, "sharp" or "blunt" lesions, lesions of shooting, compressions and iatrogenic injuries. If the spontaneous adjustment did not occur within the period of 2-6 months after the lesion, the patients underwent surgery. We performed the analysis of the efficiency of the surgical intervention depending on the following parameters: period of surgery from the lesion, patient's age, nature of lesion, degree of lesion, type of surgery intervention.

With 27 of 40 an effective adjustment was achieved preventing the sagging of the foot trace and with 25 of 40 protective sensitivity appeared. After neurolysis with 18 of 20 patients (90%) we achieved effective degree of adjustment in spite of heavy pre-surgical motor deficit. With 8 patients an "end to end" suture was performed and with 6 (75%) the degree of adjustment was 3 or higher. 12 patients requested reconstruction surgeries with the help of nerve grafts, the length of grafts varied from 4 to 20 cm. The grafts were shorter than 5 cm with 2 patients, 1 with cut lesion and 1 patient with iatrogenic lesion. With both patients the function was adjusted to the degree M4. With 1 of 4 patients (25%) with the graft of 6 to 12 cm and with none of 6 with the grafts from 13 to 20 cm the adjustment of the degree 3 or higher was not achieved. In this cases, however, we noticed partial adjustment of trophic and tonus, however at the absence of motor adjustment.

The pre-surgical and persurgical examinations are indispensable conditions for obtaining optimal results. It is worth of mentioning that surgical treatment proximal lesins of n. fibularis yielded better results than treatment of more distal lesions in the area of knee. (Tab. 5, Ref. 20.)