Palliative surgery (TP transfer) can be coupled with nerve repair as a primary treatment when a poor outcome is expected,as Prof Millesi suggested, and I believe peroneal nerve lesions strongly fit this matter, especially if neural losses of substance > 3 cm and/or contaminated/complicated (ischemic) wounds are present.
You can also find a nice review together with an interesting surgical technique in foot drop in the attachment
Article New Tendon Transfer for Correction of Drop-foot in Common Pe...
Acute lesions not associated with knee luxation can be treated with excellent results in the long term. If there is loss of nerve length, I would recommend ipsilateral superficial peroneal nerve grafts to reconstruct the peroneal nerve at the time of injury. If the injury was due to knee luxation, I would recommend tibilais posterior (TP) transfer or even better a Riordan bridle transfer. For chronic lesions, tendon transfers work better than nerve repairs/neurolysis/exploration.
Usually, a nerve repair (suture or grafting with n. suralis in cases where suture is not possible) is the treatment of choice. If the EMG and clinical follow-up after a systematic physiotherapy and electrostimulation give poor results and no signs of recovery (sometimes up to 6 months), then transfer of m. tibialis posterior should be done followed by re-education.
If injury proximal then soleus fascicles transfer to tibials ant facile in popliteal fossa (Stoffel 1911)
Dr. Power, there is a well known technique of Stoffel for resection of branches of tibial nerve in the popliteal fossa, which is appropriate for spastic equinus of the foot. Could you please describe the "soleus fascicles transfer to tibialis ant" ? I think there are some anatomical considerations which make this procedure problematic.
The stoffel operation for spasticity involves partial nerve resection to reduce afferent as well as efferent activity and maintain some muscle function. Stoffel was a keen anatomist and also defined the faciclar anatomy of the peripheral nerves using his nerve stimulation system he designed himself. There is little in the English language however referencing his original books and diagrams there is a clear explanation of the soleus nerve fasvicle and how this can be transferred to the tib ant fascicle in the popliteal fossa for spine level disease. Not suitable for transfer for injury at the peroneal tunnel / fibula neck.
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