Summary
Background
Loss of sensations in the sole following diabetic sensorimotor polyneuropathy (DSPN)
leads to diabetic foot ulcers and its sequelae. We hypothesized that sensory reinnervation
of sole by transfer of saphenous nerve (SN) to sensory fascicles of posterior tibial
nerve (PTN) in these patients may reverse the neuropathy.
Methods
This prospective interventional case series included patients with advanced DSPN and
intact sensory supply of SN. PTN was neurotized by transfer of SN nerve in the tarsal
tunnel and postoperatively sensations of the sole were tested. Any existing ulcers
on sole were noted and their healing was monitored.
Finding
A total of 17 patients (22 feet), 9 male and 8 female, were included. Seven patients
had ulcers in the feet. At 6 months follow-up all patients developed protective sensation
in the sole. The average 2 PD improved from 60 mm to 45.5 mm, average vibration perception
improved from 34.12 V to 24.33, Medical Research Council (MRC) score improved from
S0 in 12 feet and S1 in 10 feet to S3+ in 13 feet, S3 in 5 feet, and S2 in 2 feet
at 6 months along with healing of ulcers in all 7 feet.
Interpretation
Transfer of SN to PTN for sensory neurotization is an innovative and simple option
to prevent complications of DSPN. This procedure has the potential to change the natural
history of DSPN.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- IDF diabetes Atlas committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes Atlas, 9th edition.Diabetes Res Clin Pract. 2019; 157107843
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.N Engl J Med. 1993; 329: 977-986
- Comparison of risk factors for foot problems in diabetic patients attending teaching hospital outpatient clinics in four different European states.Diabetes Med. 1994; 11: 709-713
- Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India.Diabetes Care. 2007; 30: 252-256
- The global burden of diabetic foot disease.Lancet. 2005; 366: 1719-1724
- The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes.Diabetes Care. 2006; 29: 1518-1522
- Global estimates of the prevalence of diabetes for 2010 and 2030.Diabetes Res Clin Pract. 2010; 87: 4-14
- Pathways to diabetic limb amputation: basis for prevention.Diabetes Care. 1990; 13: 513-521
- Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings.Diabetes Care. 1999; 22: 157-162
- Clinical practice. Neuropathic diabetic foot ulcers.N Engl J Med. 2004; 351: 48-55
- The 14-year incidence of lower-extremi-ty amputations in a diabetic population. The Wisconsin epidemiologic study of diabetic retinopathy.Diabetes Care. 1999; 22: 951-959
- IDF Diabetes Atlas.8th ed. International Diabetes Federation, Brussels, Belgium2017
- The cost of diabetic foot ulcers and amputations to the National Health Service in England.Diabet Med. 2019; 36: 995-1002
- Evaluation of drug effects.in: Gries FA Cameron NE Low PA Ziegler D Textbook of Diabetic Neuropathy. 2003: 313-327
- Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy.Diabetic Med. 1998; 15: 508-514
- Saphenous nerve conduction in healthy subjects.Tohoku J Exp Med. May 1983; 140: 67-71
- DCCT/EDIC research group. Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the DCCT/EDIC study.Diabetes Care. Dec 2010; 33: 2635-2641
- Surgery of the Peripheral Nerve.Thieme Med. Pub., New York, NY, USA1988
- Surgical anatomy of the saphenous nerve.Ann Thorac Surg. 2008; 85: 896-900
- Causes of peripheral neuropathy: diabetes and beyond.J Fam Pract. 2015; 64: 774-783
- Clinical and nerve conduction study correlation in patients of diabetic neuropathy.J Assoc Physicians India. 2014; 62: 24-27
- Experimental diabetic neuropathy with spontaneous recovery: is there irreparable damage?.Diabetes. 2005; 54: 830-837
- Advanced diabetic neuropathy: a point of no return?.Rev Diabet Stud. 2006; 3: 143-150
- The double-crush phenomenon–an unusual presentation and literature review.Conn Med. 1999; 63: 535-538
- Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy.J Reconstr Microsurg. 2012; 28: 241-246
- The positive effect of neurolysis on patients with compressed nerves of the lower extremity: a systematic review and meta-analysis.Plast Reconstr Surg Glob Open. 2013; 1: 1-9
- Tarsal tunnel release restores sensations in sole for diabetic sensorimotor polyneuropathy.J Clin Orthop Trauma. 2020; 11: 442-447
- Wound healing in denervated tissue.Ann Plast Surg. 2006; 57: 339-342
- Sural nerve pathology in diabetic patients with minimal but progressive neuropathy.Diabetologia. 2005; 48: 578-585
- The relationship between sural nerve morphometric findings and measures of peripheral nerve function in mild diabetic neuropathy.Diabet Med. 1991; 8: 917-921
- Influence of experimental diabetes on the microcirculation of injured peripheral nerve: functional and morphological aspects.Diabetes. 2002; 51: 2233-2240
- Regeneration of long‑distance peripheral nerve defects after delayed reconstruction in healthy and diabetic rats is supported by immunomodulatory chitosan nerve guides.BMC Neurosci. 2017; 18: 53
- Evaluation of nerve regeneration in diabetic rats.Acta Cir Bras. 2013; 28: 509-517
- The extracellular matrix of peripheral nerve in diabetic polyneuropathy.Acta Neuropathol. 2000; 99: 539-546
- Sensory receptors.(editor)in: Gelberman R Operative Nerve Repair and Reconstruction, vol. I. Lippincott, Philadelphia: JB1991
- Saphenous nerve transfer: a new approach to restore sensation of the sole.J Plast Reconstr Aesthet Surg. 2018; 71: 1704-1710
- Gastric bypass leads to improvement of diabetic neuropathy independent of glucose normalization–results of a prospective cohort study (DiaSurg 1 study).Ann Surg. Nov 2013; 258 (discussion 765-6): 760-765
- Effects of pancreatic transplantation on diabetic neuropathy.N Engl J Med. 1990 Apr 12; 322: 1031-1037
- Prevalence and forms of neuropathic morbidity in 800 diabetics.Ir J Med Sci. 1994; 163: 132-135
- Diabetic neuropathy– a continuing enigma.Diabetes Metab Res Rev. 2000; 16: 408-433
- Femoral nerve transfers for restoring tibial nerve function: an anatomical study and clinical correlation: a report of 2 cases.J Neurosurg. 2017; 3: 1-10
- Recovery potential of muscle after partial denervation: a comparison between rats and humans.Brain Res Bull. 1993; 30: 477-482
- Innervation ratio and motor unit force in large muscles: a study of chronically stimulated cat medial gastrocnemius.J Physiol. 1997; 15 (Pt 3): 809-823
- Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests.J Hand Surg. 2005; 30B (British and European Volume): 252-264
Article info
Publication history
Published online: February 05, 2021
Accepted:
January 24,
2021
Received in revised form:
December 14,
2020
Received:
October 7,
2020
Identification
Copyright
© 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
