Pertinent Insights On Surgical Decompression For Common Peroneal Nerve Entrapment

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A Few Pearls For Successful Management Of Common Peroneal Nerve Decompression

1. Complete formal peripheral nerve surgery training
2. Use of 3-4x surgical loupes (preferably with headlight)
3. Avoidance of monopolar cautery
4. Immediate mobilization after surgery
5. Use of blunt dissection only once through the skin
6. Use of extreme care when entering and dissecting in the lateral compartment
7. Precise incision placement
8. Patient positioning with a flexed knee position
9. Understand that there is a “learning curve” and that working with an experienced surgical mentor during the initial cases can accelerate competence

Stephen L. Barrett, DPM, MBA, FACFAS, FAENS

What You Should Know About Postoperative Management

Patients may be fully weightbearing immediately after surgery and one should encourage them to begin walking modestly that day. In order to avoid the potential for hematoma, advise patients to walk only to the point of necessity the first 48 hours. Strongly recommend that they begin flexion and extension of the knee repeatedly.

   As with all lower extremity peripheral nerve surgery, nerves need to slide and glide. Nothing can destroy the ultimate outcome of peripheral nerve surgery as much as immobilization of the patient after a neurolysis.

   One can usually remove sutures at 14 days but in patients with metabolic disease, sutures can stay in as long as one month to prevent dehiscence.

In Summary

Entrapment of the common peroneal (fibular) nerve is common and we frequently only recognize it when there is severe motor loss, except in the case of the experienced practitioner who has a high degree of suspicion and clinical diagnostic acumen. Patients who present with seemingly unrelated symptoms should always have evaluation for entrapment of this nerve as physicians so commonly miss the diagnosis.

   Dr. Barrett is an Adjunct Professor in the Arizona Podiatric Medical Program at the Midwestern University College of Health Sciences. He is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Barrett is a Fellow and the incoming President of the Association of Extremity Nerve Surgeons.

   The author discloses that he is a shareholder in Sensory Management Services, which manufactures the Pressure Specified Sensory Device (PSSD).

   This article is excerpted from a chapter in the textbook “Practical Pain Management For The Lower Extremity Surgeon,” (in press) with the permission of the publisher, Data Trace.


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