Delayed compression of the common peroneal nerve following rotational lateral gastrocnemius flap: case report

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The authors present a case of delayed peroneal neuropathy following a lateral gastrocnemius rotational flap reconstruction. The patient presented 1.5 years after surgery with a new partial foot drop, which progressed over 3 years. At operation, a fascial band on the deep side of the gastrocnemius flap was compressing the common peroneal nerve proximal to the fibular head, correlating with preoperative imaging. Release of this fascial band and selective muscle resection led to immediate improvement in symptoms postoperatively.

ABBREVIATIONS EMG = electromyography.

Article Information

Correspondence Robert J. Spinner, Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. email: spinner.robert@mayo.edu.

INCLUDE WHEN CITING Published online July 28, 2017; DOI: 10.3171/2017.2.JNS162711.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    A: Axial proton density MR image of the left knee at the level of the femorotibial joint line. Stars indicate the rotated lateral gastrocnemius flap reconstruction. The arrow indicates the enlarged common peroneal nerve. The dashed rectangle represents the section enlarged and described in Fig. 2. B: Coronal proton density MR image of the left knee. The dotted white line shows the course of the common peroneal nerve including around the proximal fibula (black star). A low signal intensity fascial sling (arrows) created by the rotated lateral gastrocnemius flap (white stars) is shown.

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    A: Enlarged axial proton density MR image section outlined by the dashed rectangle in Fig. 1A. Enlarged peroneal nerve (dot) partially encircled and compressed by a low signal intensity fascial sling (arrows) created by the rotated lateral gastrocnemius flap. B: Corresponding ultrasound image obtained 2.5 years following the MRI denoting the same findings.

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    Intraoperative photographs. A: The common peroneal nerve (blue vessel loop) exiting from beneath the gastrocnemius rotational flap (dashed black line). B: A tight fascial sling (arrow) overlying the common peroneal nerve (blue vessel loop) was identified and divided. C: The common peroneal nerve was identified proximal (black arrow) and distal (white arrow) to a tunnel created by the gastrocnemius rotational flap. Division of a tight fascial sling and selective muscle resection ensured the nerve to be free throughout the tunnel.

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    A: Immediately postoperatively in the recovery area, the patient demonstrated significant recovery of dorsiflexion. B and C: Three weeks postoperatively his incision was healing well and he had regained nearly normal foot dorsiflexion.

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