Lower extremity nerve transfers: an under-appreciated reconstructive approach

Abstract

Lower extremity peripheral nerve injuries can be highly morbid to patients and challenging problems for reconstructive surgeons to manage. Nerve transfers have recently emerged as a promising technique in the treatment of these injuries. The nerve-transfer paradigm is predicated on the use of an expendable, unaffected nerve as a donor of axons to restore motor or sensory function in the target end organ. Distal transfers close to the end motor or sensory organ may allow for earlier and more robust reinnervation compared to more proximal primary repair or grafting. However, as clinical data on outcomes and rigorous comparative studies remain scarce, reconstructive surgeons must rely on principle-based treatment including a detailed understanding of lower extremity neuromuscular anatomy, gait mechanics, and nerve physiology to develop an appropriate treatment plan for each patient with the goal of functional limb restoration and independent gait. In this article, we review current concepts of lower extremity nerve transfers, including techniques and outcomes according to indication.