Peripheral Nerve Reconstruction in Lower Extremities: Institutional Experience of Chang Gung Memorial Hospital

Lower-extremity nerve reconstruction, most commonly involving the lumbosacral plexus (LSP), sciatic nerve (including common peroneal and posterior tibial nerves), and the femoral nerve, remains one of the most demanding challenges in peripheral nerve surgery, with outcomes primarily determined by injury mechanism, anatomical level, and timing of reconstruction. Over the past 35 years (1987-2022), the Peripheral Nerve Team at the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan treated 3 patients with LSP injuries, 6 patients with femoral nerve injuries, and 35 patients with sciatic nerve injuries using different surgical techniques, including neurolysis, direct nerve repair, cable grafting, nerve transfer, vascularized nerve grafting, and adjunctive procedures such as functioning free muscle transplantation (FFMT) and tendon transfer. The corresponding surgeons included D.C-C.C., T.N-J.C., and J.C-Y.L. as the senior authors in this paper. Meaningful recovery clustered with early timing and tension-free nerve coaptation; in selected long-segment or scarred beds, well-constructed multistranded or vascularized grafts achieved useful function, yet the superiority of vascularized constructs was not uniform across cases. Delayed exploration and isolated neurolysis generally yielded limited improvement. Although functional recovery declined with increasing graft length, satisfactory results were observed in selected extensive reconstructions using multiple grafts appropriately and, when indicated, FFMT. These observations highlight the complexity of lower-extremity nerve reconstruction and the need for careful surgical planning and long-term follow-up to optimize outcomes after nerve reconstruction in the lower extremities.