A Technique to Reconstruct a Nerve Injured at Its Bifurcation Site Using Autograft and End-to-Side Neurorrhaphy

Peripheral nerves injuries are relatively frequent after high-energy trauma in both upper and lower limb. This case report describes the reconstruction of a 5-cm nerve defect involving the superficial peroneal nerve (SPN) where it divides into its two terminal branches. A 5-cm nerve graft was harvested from the proximal part of the medial dorsal cutaneous nerve (MDN) and interposed to fill the gap between the distal stump of the SPN and the intermediate dorsal cutaneous nerve (IDN). The stump of the MDN was then sutured with an end-to-side (ETS) technique to the IDN, distally to the nerve graft, by opening a window in the epineurium of IDN. The sensory restoration of the dorsal area of the foot after 8 months was evaluated satisfactory from the authors. Tenderness and Tinel's sign at the lesion site were not present. The patient's satisfaction was excellent. The results of this case may suggest that a nerve defect involving a bifurcation point can be treated with satisfactory results using one distal stump as donor nerve for a nerve autograft to bridge the nerve gap followed by an ETS neurorrhaphy of donor one on the other stump. In this way, it is possible to reconstruct a bifurcation point by creating a new division point with the same Y-shape in a more distal position, without adding morbidity due to the harvesting of a nerve graft from another area of the body.