Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication

Abstract

Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications.

Keywords

• Drop foot; iatrogenic nerve injury; posterior tibial nerve.

Posterior tibial sinirin tendon transferi olarak kullanılması: Yıkıcı komplikasyon

Abstract

Birçok medikal işlem iatrojenik periferal sinir yaralanması ile sonuçlanmaktadır. İatrojenik sinir yara­lanmasında ana nedenler, kesilme, gerilme, kompresyon, enjeksiyon, sıcak, radyasyon, ve antikoagulan ajanlar olabilir. Tanıdaki gecikme motor son durakta atrofiye ve buda sonuçların kötü olmasına neden olmaktadır. Biz düşük ayak rekonstrüksiyonu için tibialis posterior sinirinin tibialis posterior tendonu olduğu düşünülerek kazara kesilip tibialis anterior tendonuna transfer edildiği olgu sunumunu rapor ediyoruz. Bundan dolayı, bu iatrojenik komplikasyon ayak ampütasyonuna neden olmuştur. Bu tür komplikasyonalar konusunda uyanık olunması amacı ile bu olguyu meslektaşlarımızla paylaşmak is­tedik

Keywords

• Düşük ayak; iatrojenik sinir yaralanması; tibialis posterior siniri.

References

1. Kretschmer T, Antoniadis G, Braun V, Rath SA, Rich- ter HP. Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg 2001;94:905-12. CrossRef
2. Birch R, Bonney G, Dowell J, Hollingdale J. Iatro- genic injuries of peripheral nerves. J Bone Joint Surg Br 1991;73:280-2.
3. Kömürcü F, Zwolak P, Benditte-Klepetko H, Deutinger M. Management strategies for peripheral iatrogenic nerve lesions. Ann Plast Surg 2005;54:135-9; discussion 140-2.
4. Khan R, Birch R. Latropathic injuries of peripheral nerves. J Bone Joint Surg Br 2001;83:1145-8. CrossRef
5. Kim DH, Ryu S, Tiel RL, Kline DG. Surgical manage- ment and results of 135 tibial nerve lesions at the Louisi- ana State University Health Sciences Center. Neurosur- gery 2003;53:1114-25. CrossRef
6. Kiliç A, Parmaksizoğlu AS, Kabukçuoğlu Y, Bilgili F, Sökücü S. Extramembranous transfer of the tibialis posterior tendon for the correction of drop foot deformity. Acta Orthop Trau- matol Turc 2008;42:310-5. [Article in Turkish] CrossRef
7. Vigasio A, Marcoccio I, Patelli A, Mattiuzzo V, Pres- tini G. New tendon transfer for correction of drop-foot in common peroneal nerve palsy. Clin Orthop Relat Res 2008;466:1454-66. CrossRef
8. McGeorge D, Sturzenegger M, Buchler U. Tibial nerve mistakenly used as a tendon graft. Reports of three cases. J Bone Joint Surg Br 1992;74:365-6.