Common peroneal nerve decompression, neurolysis and wrapping with the AxoGen AxoGuard nerve protector surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Common peroneal nerve decompression, neurolysis and wrapping with the AxoGen AxoGuard nerve protector surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Common peroneal nerve decompression, neurolysis and wrapping with the AxoGen AxoGuard nerve protector surgical procedure.
The common peroneal nerve is vulnerable to injury from direct trauma at the knee or from traction associated with knee dislocation. The presentation is with footdrop due to loss of the function in tibialis anterior and toe extensors supplied through the deep peroneal nerve. In addition there is loss of peroneal tendon function due to loss of the superficial peroneal nerve. There is sensory loss on the dorsum of the foot.
The decision to operate and decompress the nerve should be made by an experienced nerve surgeon after careful clinical examination, repeated examination if necessary and sometimes supportive imaging and neurophysiological assessments. Typically the decision can be made on the basis of the clinical assessment alone. A dense painful lesion with a positive Tinel’s sign at the peroneal tunnel, a deepening lesion with deterioration under observation, a non-recovering lesion or diagnostic uncertainty are all indications for exploration.
The surgeon should be prepared for the need for reconstruction in a complete lesion should a rupture or a severe attenuation lesion be identified at surgery. Additional procedures including allograft, autograft and distal motor nerve transfers are covered elsewhere. The AxoGuard nerve protector (AxoGen) is a layered porcine collagen extracellular matrix that can be used to wrap scarred nerves where there is epineurial damage and it rapidly revascularises and restores gliding around injured nerves and acts as a barrier to further scar formation that could impair neural regeneration or cause further deterioration due to nerve tether.
The case presented demonstrates the decision making in complex nerve trauma and describes the use of an AxGuard to protect a nerve following decompression at the site of injury.
Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.