SURAL NERVE GRAFTING FOR LOWER-EXTREMITY NERVE INJURIES

Fourteen consecutive patients who had sural nerve grafts to reconstruc t the sciatic or peroneal nerve were retrospectively evaluated to dete rmine the functional return of reinnervation. A standardized functiona l evaluation to assess motor and sensory return of the injured compare d with the contralateral side was employed as a means of normalizing t he data. The dorsiflexion and plantar flexion strength were quantitati vely measured to determine the recovery of muscle strength, and record ed as a percentage of the strength of the contralateral extremity as w ell as by assigning a motor grade. Sensory recovery was evaluated by s ensory grade, two-point discrimination, and response to Semmes-Weinste in monofilaments. The average age of these 14 patients was 20 years (r ange 8-63 years). All but one of the patients regained protective sens ation and five patients regained useful motor function. Four of the fi ve patients regaining useful function were pediatric patients. Improve d 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, ca n occur in children but is a rare occurrence in the adult patient alth ough protective sensation is routinely gained and disabling paresthesi as from neuromas are avoided.