So now that the common peroneal nerve is delivered into the field, you can see a significant neuroma of that common peroneal nerve. That dissection proceeds approximately in order to be able to mobilize that common peroneal nerve towards the recipient motor branch to the gastroc. And now the neuroma is resected, and again, resecting back approximately enough to have healthy nerve fascicles to work with. So this is a technique that's been described by Ian Valerio and Kyle Eberlin. And so this is the concept of using a muscle flap, a denervated muscle flap, to reinforce the coaptation given the anticipated size mismatch. So the recipient motor nerve to the gastroc is then divided. And again, a centralizing stitch is performed with 8-0 proline in order to deliver this recipient nerve into the mid-portion of the much larger common peroneal nerve. So now you see that recipient nerve being delivered into the mid-portion of the common perineal nerve. And given the significant size match and the fact that it's unlikely that we'd be able to perform epineural-to-epineural coaptations without severely constricting the donor common perineal nerve, we're going to use this muscle flap and perform epineural-to-epimuseal reinforcing sutures so that the axons that are not delivered into the recipient nerve are delivered directly into this now denervated lateral gastroc muscle.

neuroma

nerve coaptation

muscle flap technique

common peroneal nerve

axon targeting