Implantable Neuromodulation Device in the Lower Limb: An Adjunctive Procedure in Patients with Continued Chronic Pain After Failed Revisional Microneurosurgical Procedure in a Nonreconstructable Zone of Injury.

Implantable peripheral nerve stimulators are used with the goal to decrease the neuropathic pain level and possibly the need for opioid analgesics. Peripheral nerve injuries and pathology must be thoroughly evaluated before implantation of neuromodulation devices. Ultrasound-guided nerve blocks and a peripheral nerve stimulator trial is performed before surgical implantation. In this article, the authors discuss indications, clinical and diagnostic examinations, and their surgical technique for implantation of the Bioventus StimRouter.

Evaluation and Treatment of Foot Drop Using Nerve Transfer Techniques.

Foot drop represents a complex pathologic condition, requiring a multidisciplinary approach for appropriate evaluation and treatment. Multiple etiologic factors require recognition before considering invasive/operative intervention. When considering surgical management for the treatment of foot drop, it is first and foremost imperative to establish the cause of the condition. Not all causes resulting in clinical foot drop have surgical options. Establishing a cause allows the provider to more appropriately curtail a multidisciplinary approach to working-up, and ultimately, treating the patient. The authors offer an algorithm for evaluating and treating foot drop conditions associated with lumbar spine radiculopathy and peripheral nerve lesions.

Healing Heel Ulcers in High-Risk Patients: Distally Based Peroneus Brevis Muscle Flap Case Series.

The purpose of this study was to demonstrate use of a distally based peroneus brevis muscle flap in high-risk patients with diabetes and peripheral vascular disease for limb salvage of nonhealing heel ulcerations. Seventeen patients were referred for a below-knee amputation because of nonhealing heel ulcerations and peripheral vascular disease. As a last resort, 17 distally based peroneus brevis muscle flaps were elevated in 17 patients with full-thickness heel ulcerations measuring an average defect size of 14.11 cm2. All flaps were supplemented with concentrated bone marrow aspirate, negative pressure wound therapy, bilayer wound matrix, and static external fixation for an average time of 10.3 weeks. Split-thickness skin graft was delayed by an average of 17.5 days. All procedures were performed on patients diagnosed with diabetes, advanced peripheral arterial disease and a nonhealing heel ulcer present >1 year. All flaps survived at 1.5 years follow-up. The average time to healing was 10.3 weeks. No major amputations were performed to date. Partial tip necrosis occurred in 2 patients and healed uneventfully with local wound care. Distally based peroneus brevis muscle flaps in patients with diabetes and peripheral vascular disease offer a reliable alternative to limb salvage for full-thickness heel ulcerations measuring up to 7 × 6 cm. Combinatorial procedures are necessary to improve outcomes in high-risk patients whose alternative is a major amputation.