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Qiu et al. Plast Aesthet Res 2022;9:19 Plastic and
DOI: 10.20517/2347-9264.2021.126
Aesthetic Research

Review Open Access

Functional reconstruction of lower extremity nerve
injuries

Cecil S. Qiu, Philip J. Hanwright, Nima Khavanin, Sami H. Tuffaha

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Correspondence to: Dr. Sami H. Tuffaha, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of
Medicine, 601 N. Caroline St. Suite 8161, Baltimore, MD 21287, USA. E-mail: stuffah1@jhmi.edu

How to cite this article: Qiu CS, Hanwright PJ, Khavanin N, Tuffaha SH. Functional reconstruction of lower extremity nerve
injuries. Plast Aesthet Res 2022;9:19. https://dx.doi.org/10.20517/2347-9264.2021.126

Received: 30 Nov 2021 First Decision: 10 Jan 2021 Revised: 27 Jan 2021 Accepted: 10 Feb 2021 Published: 18 Mar 2022

Academic Editor: Matthew L. Iorio Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Peripheral nerve injuries (PNI) in the lower extremity are an uncommon but highly morbid condition. Recent
advances in our understanding of nerve physiology and microsurgical techniques have inspired renewed faith in
nerve surgery and sparked a creative renaissance in the tools, approaches, and reconstructive schemas available to
surgeons in the management of lower extremity PNIs. In this article, we review the literature and provide a
principles-based approach for the surgical management of lower extremity PNIs with an emphasis on techniques
for functional reconstruction after complete nerve injury. General principles in management include early diagnosis
with electrodiagnostics and imaging, early surgical exploration, and opting for nerve and tendon transfers when
primary reconstruction of the injured nerve is unfavorable (e.g., delayed reconstruction, unavailability of proximal
or distal nerve stumps, or long regenerative distance). The goal of functional reconstruction should be to restore
independent gait, so understanding the roles of major neuromuscular units during the gait cycle informs the
selection of donor nerves and tendons for transfer. Based on these principles and literature to date, specific
algorithms for surgical management are presented for femoral, sciatic, tibial, and common peroneal nerves. We
recognize limitations of the current literature, namely the predominance of case series evidence, and call for the
accrual of more patient data in surgical management of PNIs.

Keywords: Nerve, nerve transfer, tendon transfer, gait

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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