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In this experimental study, microsurgical centrocentral anastomosis was applied to an experimental model of painful terminal neuroma resulting from left sciatic nerve section in the rat. The anastomosis consisted of end-to-end suturing of the sciatic nerve fascicles to the tibial branch, with the interposition of a nerve graft taken from the same anastomosed fascicle. As a control parameter for the experiment, the autotomy which follows sciatic nerve section in the rat was evaluated. Autotomy is considered an objective indication of abnormal sensations that are provoked by the formation of a terminal neuroma. Histological study of the proximal stump of the sciatic nerve was also performed. The observation period was 10 weeks. The study demonstrates that centrocentral anastomosis reduces the size of the neuroma formation and the incidence of autotomy.

Isolated division of the tibial nerve in the thigh preserving the peroneal and sural nerves does not cause loss of normal position of the animal, in particular of sitting. Nor does it lead to pressure sores. The animals are fitter then after division of the sciatic nerve. Microsurgical suture of the isolated tibial nerve in the thigh of the rabbit with 1 or 2 simple sutures with 10 x 0 thread show that an average recovery can be achieved in over 80 per cent. As few sutures as possible should be used. Otherwise there with be scarring and no return of function.

Changes in length and mass of mouse soleus muscles have been determined during the first 14 days after division of the Achilles tendon and/or the tibial nerve. Muscle atrophy and associated histological changes were detectable 24 h after tenotomy, and increased progressively over the first week. These changes were less marked in muscles which had also been denervated, and were rapidly reversed if the tendon became reattached. An attempt is made to distinguish the role of the nerve supply from the effects of reduced longitudinal tension in the production of atrophy after tenotomy.

An illustrative case report and a review of the literature are presented. The tarsal tunnel syndrome is a relatively rare syndrome consisting of pain, paresthesias, and varying degrees of motor and vasomotor changes in any or all three branches of the posterior tibial nerve at the ankle. It represents a pressure neuropathy secondary to intrinsic or extrinsic stenosis of the tarsal tunnel, with a wide variety of underlying causes. The clinical suspicion may be confirmed by electromyography and nerve conduction studies, comparing motor and sensory action potential latency, amplitude and duration to that of the uninvolved foot. Surgical decompression affords the only consistent good results with an 80% to 90% cure rate.

The author present his experience of the repair of nerve lesions in the lower limb. The cases are classified into four main groups: traumatic lesions; acute and chronic compression; tumours and leprosy. The traumatic lesions include those associated with a clean wound, missile injuries, traction injuries and a miscellaneous group. The diagnosis and treatment of the different lesions are discussed. The results of nerve grafting using microsurgical techniques are presented. The results are good enough, even in severe traction injuries, to recommend the repair of nerve lesions of the lower limbs in the circumstances which are outlined.

Seventy-one cases of posterior tibial neurovascular surgical decompression in leprosy are analyzed and reviewed. Thirteen had chronic refractory posterior tibial neuritis while 58 had chronic nonhealing plantar ulcers. The plantar ulcers were associated with posterior tibial neuritis and/or vascular insufficiency. The clinical and operative findings together with the results are presented and the physiopathology of neurovascular compression is discussed. The operative procedure is described. The presence of pale granulation tissue in a nonhealing ulcer seems to be a characteristic finding in these cases. Neurovascular compression in the tunnel, behind and also below the malleolus, was present in all. In operative procedures, the importance of incising the inferior calcaneal bands is stressed. The results show that the neuritis was cured in all cases, while in 53 of 58 cases the plantar ulcers healed in a short period after the decompression. This stresses the value of this procedure. The prophylactic potential of this procedure needs to be evaluated.

This review deals with the long-term results of selective peripheral neurotomy (SPN) of the tibial nerve and selective posterior rhizotomy (SPR) in 123 cases of severe spastic syndromes in the limbs. The microtechniques and preoperative electrostimulation for identification of the nervous structures responsible for the spastic components give to these methods an advantage of a substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory functions. The results were effective, with a 1- to 13-year follow-up, in 89% of 47 SPN of the tibial nerve for spastic foot, in 92% of 53 SPR for paraplegia and in 87% of 23 SPR for hemiplegia.

Experiments in rats, introducing the proximal and distal stumps of tibial and sural nerves into a vein graft, showed by acetylcholinesterase and toluidine blue staining that sensory and motor fibers mix inside the vein graft, but that nevertheless they are able to select their distal targets correctly. The authors' hypothesis is that surface membrane antigens of Schwann cells might be responsible for this chemotactic phenomenon.