Tibial Nerve to Tibialis Anterior Motor branch of Deep Peroneal nerve transfer in a case of Foot drop.pptx

Andrea Baeuer MD , Boston Children Hospital

1. Tibial Nerve to Tibialis Anterior Motor branch of Deep Peroneal nerve transfer in a case of Foot drop

2. 1 Under GA 2 Lateral Decubitus position 3 Oblique incision is made centered over the Fibular head.

3. 4 CPN divides into Superficial and Deep peroneal nerve at neck of Fibula

4. 5 Deep Peroneal nerve is inbetween Peroneus Longus and Soleus muscle

5. 6 After identification Deep Peroneal nerve , interval between Peroneal Longus and Soleus was made after opening fascia over it.

6. 7 Peroneal muscle elevated from anterior Fibula and Deep Peroneal nerve is traced as it gives off motor branch to Tibialis Anterior muscle.

7. 8 Soleus is elevated from posterior aspect of Fibula to expose and protect the Posterior Tibial neurovascular bundle.

8. 9 Intrafacicular dissection Tibial nerve was done and redundant fascicles to FHL and FDL muscles were identified using nerve stimulator

9. 10 Coaptation can be done either above fibula or below Fibula.