Sural nerve grafting for lower extremity nerve injuries

Fourteen consecutive patients who had sural nerve grafts to reconstruct the sciatic or peroneal nerve were retrospectively evaluated to determine the functional return of reinnervation. A standardized functional evaluation to assess motor and sensory return of the injured compared with the contralateral side was employed as a means of normalizing the data. The dorsiflexion and plantar flexion strength were quantitatively measured to determine the recovery of muscle strength, and recorded as a percentage of the strength of the contralateral extremity as well as by assigning a motor grade. Sensory recovery was evaluated by sensory grade, two-point discrimination, and response to Semmes-Weinstein monofilaments. The average age of these 14 patients was 20 years (range 8-63 years). All but one of the patients regained protective sensation and five patients regained useful motor function. Four of the five patients regaining useful function were pediatric patients. Improved functional outcome was correlated to the nerve injured, patient age, mechanism of injury, length of graft, and the delay to grafting. The return of lower extremity function, obviating the need for bracing, can occur in children but is a rare occurrence in the adult patient although protective sensation is routinely gained and disabling paresthesias from neuromas are avoided.