Due to any trauma, road traffic accident, nerves can be damaged and patient can have the following
symptoms.
SYMPTOMS 

• Numbness in foot and toes
• Tingling sensation
• Altered sensation as compared to other limb
• Pain in leg
• Burning sensation
• Decrease in muscle power of foot and legs

In order to treat such injuries there are multiple options and procedures available
Depending upon duration of injury, injury type, and site of injury.
1. PRIMARY NERVE REPAIR 
If there is sharp cut wound with the above symptoms then high chances of transection of nerve need to
explore the injury site and repair primarily (end to end sewn) the damaged part.
2. NERVE GRAFT 
Graft is basically a segment of tissue taken from other site of body of same patient if the duration of
injury exceeds more than 3 months and there is no sign of recovery then we can explore the injury site
and repair the damaged nerve segment with a nerve graft to bridge the gap.
3. NERVE TRANSFER 
If the injury site is scarred, and/or high above on the limb and duration is 3-9 months, then nerve
transfer can be an option. It means restoring the nerve supply near to the target tissue or organ.
Now let us see some clinical scenarios
FOOT DROP 
A patient is unable to elevate foot at ankle joint (Dorsiflexion) secondary to injury of Common Peroneal
Nerve at the level of knee or high above knee.
TREATMENT OPTIONS 

• Nerve repair via one of the above options if duration of injury is up to 9-12 months.
• Tendon transfer with donating a tendon which lowers down the foot (plantar flexion) to the
  non-motorized dorsiflexor tendon mostly after 12 months of injury.

For both the above procedures patient needs to get admitted for some days depending upon severity of
injury.

• Procedures are done under general anesthesia.
• After the procedure done the operated limb is placed in a customized plaster splint which is
  there for at least 4-6 weeks.
• There will be a supervised physiotherapy during and after the hospital stay till at least 8-12
  weeks and the limb gains its power.

COMPLICATIONS 

There can be some side effects of the procedures but very low chances in expert hands like

• Pooling of blood (hematoma)
• Infection
• Wound issues (dehiscence)
• Loosening of repair
• Failure of the procedure.

NUMB FOOT 

Loss of sensation due to injury to Sciatic Nerve High above the level of knee
Treatment option is the same as of nerve repair depending upon the duration of injury as mentioned
above.

RECOVERY 
After nerve repair nerve grows at 1inch per month speed from the site of repair so it will take time to
get results of nerve repair usually in 6 months till 2 years, depending upon the level of injury and site of
repair. For nerve transfer duration of recovery is shortened as it is close to the target tissue.
For tendon transfer recovery is there just after repair but depends upon the adherence of patient to
physiotherapy protocol.

 

Written by : Dr. Ali Adnan
Copyrights: Pakistan association of Plastic Surgeons