• Journal of Oriental Neuropsychiatry
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• v.15 no.1
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• pp.149-153
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• 2004

This report present on a case of common peroneal nerve palsy effectively treated with oriental medical therapy. Common peroneal nerve palsy caused by compression of nerve, general illness(diabetes mellitus) etc. It occur foot drop, disorder of ankle dorsi-flexor and eversion, disorder of foot sensory. If nerve palsy is progressed, muscle atropy is occurred. This patient fall foot drop before two month ago without reason. He is diagnosed as peroneal nerve palsy by brain MRI, EMG and doctor's physical examination. This patient effectively treated by oriental medical therapy. Oriental medical therapy is herb medicine(kamisamul-tang), acupuncture(S36, S38, S40, S41, G34, G39, G40, G41, LIV3, LIV4, K3, B60), Electro-acupuncture, bee venom acupuncture, moxibustion, electro physical therapy(EST, SSP). Time of therapy is two months and sequela is nothing.

• Annals of Clinical Neurophysiology
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• v.6 no.1
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• pp.31-34
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• 2004

Backgrounds: The pathway of the sural nerve (SN) is variable, but usually divided into medial and lateral sural branches joining the posterior tibial nerve (PTN) and the peroneal nerve (PN). The sural nerve may be affected by PN palsy. The frequency or the severity of SN involvement in peroneal palsy is not known. The purpose of the study is to investigate the frequency and the severity of the SN involvement by the peroneal nerve palsy. Methods: Total 85 patients were included with peroneal palsy. Amplitudes of distal peroneal, sural, and superficial peroneal nerves (SPN) were compared between normal and paralyzed sides. The frequency and severity of SN involvement by peroneal palsy were investigated. Results: Mean age was $48.4{\pm}17.4$ years old at the time of the test. Peroneal palsy was right side in 32, left in 38, and bilateral in 15 patients. Mean amplitudes of affected distal PN, SPN, and SN were $1.51{\pm}1.64mV$, $3.50{\pm}4.86{\mu}V$, and $10.42{\pm}6.59{\mu}V$ in right side, and $1.19{\pm}1.57mV$, $4.38{\pm}5.67{\mu}V$, and $11.06{\pm}6.87{\mu}V$ in left side, respectively. Sensory nerve action potential (SNAP) amplitude of the SN in the affected side was average $73.7{\pm}33.1%$ of normal, which was significantly lower than that in the normal side(p<0.01). The decrease of the sural SNAP amplitude was more than 15% in 39 out of 70 patients with unilateral peroneal palsy. Peroneal compound muscle action potential (CMAP) amplitude was not correlated with the amplitude of the sural SNAP. By complete peroneal palsy, SN SNAP amplitude was decreased to 4% of SNAP and $57.7{\pm}31.8%$ of that in normal side. Conclusions: PN injury without PTN involvement may induce reduction of sural SNAP amplitude. Because of the anatomic variation of SN, the electrophysiological findings are variable. It should be considered to interpret the location of the PN lesion.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.88-94
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• 1998

Free vascularized fibular transplantation is one of the most useful living bone reconstructive procedure in microsurgical field. Concerning about donor site morbidity, the donor has minor problems of ankle stability and muscle power weakness and transient peroneal nerve symptoms. That problems can be minimized with longitudinal splitted osteotomy on the donor fibula if the bone defect in recipient site is not so large. Half splitted fibula with peroneal arterial pedicle which contains nutrient artery and periosteal vessels, grafted bone can survive with those vascular supplies. Authors underwent five cases of half splitted free vascularized fibular transplantation from 1985. There were no evidence of devascularization in all cases, we can minimized donor morbidity with leaving half fibula intact on donor site. The problem of that technique is technically demanding in longitudinal splitting of bone without damage to peroneal nutrient vessels and periosteal soft tissues which attached to the bone. Authors can propose longitudinal half fibular transplantation is one of modification in free vascularized bone transplantation that minimize donor defect.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.12-17
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• 2001

Recovery of nerve injury is conditioned by various factors including physical state, injured site, cause of injury, and neurorrhaphy Many researchers have reported on regeneration of nerve using end to side neurorrhaphy. The purpose of this study was to examine regeneration of nerve in various conditioned side to side neurorrhaphy. Total of 25 male Sprague-Dawley rats weighing 220 to 250 gm were divided into five groups of five rats each. The group 1, sham group, composed of dissection only without nerve transaction. The group 2, control group, composed of nerve division only without neurorrhaphy or sural nerve graft. The group 3 composed of one segmental sural nerve graft between the tibial and peroneal nerve after division. Group 4 had two segment graft, and the group 5 with three segment graft, each segment being 6mm long and 5 mm apart. The side to side neurorrhaphy was performed between peroneal nerve and tibial nerve using segmental sural nerve graft in rats. We exposed the sciatic nerve, tibial nerve, peroneal nerve, and sural nerve on left side with prone position. The peroneal nerve was cut on the bifurcation site from tibial nerve and the side to side epineurial neurorrhaphy was performed between peroneal nerve and tibial nerve through 6 mm sural nerve segment graft with 11-0 nylon under operating microscope. The electromyography and the weight from ipsilateral tibialis anterior muscle was performed at one month after neurorrhaphy Peroneal and tibial nerve was examined at distal and proximal to the neurorrhaphy site by methylene blue stain under light microscope for histologic appearance. The number of nerve fibers were counted using the image analyzer. Statistically, both in electromyography and number of nerve fibers, the differences in values between the groups were significant.

• Annals of Clinical Neurophysiology
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• v.12 no.1
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• pp.11-15
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• 2010

Background: In belly-tendon (bipolar) montage, reference (R2) electrode placed on muscle's tendon has traditionally been considered to be electrically inactive. However, recent studies have revealed that R2 electrode is not simply referential, but actively contributes to compound muscle action potential (CMAP) waveform morphology. These findings suggest that CMAP onset latency and amplitude may also be influenced by the position of R2 electrode. This study was performed in order to evaluate the effect of R2 electrode position on CMAP onset latency and amplitude. Methods: We performed motor nerve conduction studies of median, ulnar, tibial and peroneal nerves on bilateral limbs of 20 normal subjects. We used traditional bipolar and monopolar montage and compared their CMAP onset latencies and amplitudes. In bipolar montage, recording (R1) electrode was placed on mid-belly of muscle with R2 electrode on the tendon of the muscle. In monopolar montage, R1 electrode was placed on the same site of bipolar montage, while R2 electrode was placed on the contralateral limb. Results: The mean CMAP onset latencies of median and peroneal nerves in bipolar montage were significantly different (p<0.05) with those in monopolar montage. And those of ulnar and tibial nerves were not significantly different (p>0.05). The mean CMAP amplitudes of all the tested nerves except ulnar nerve were significantly different (p<0.05). Conclusions: This study shows that change in R2 electrode position can affect the CMAP onset latency and amplitude, and these differences seem to be related to the generation of far field potential by CMAP.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.324-331
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• 2023

Objective : We aimed to analyze the effectiveness of external neurolysis on the common peroneal nerve (CPN) in patients with posture-induced compressive peroneal neuropathy (PICPNe). Further, we aimed to examine the utility of magnetic resonance imaging (MRI) in assessing the severity of denervation status and predicting the postoperative prognosis. Methods : We included 13 patients (eight males and five females) with foot drop who underwent CPN decompression between 2018 and 2020. We designed a grading system for assessing the postoperative functional outcome. Additionally, we performed MRI to evaluate the denervation status of the affected musculature and its effect on postoperative recovery. Results : The median time to surgery was 3 months. The median preoperative ankle dorsiflexion and eversion grades were both 3, while the average functional grade was 1. Posterior crural intermuscular septum was the most common cause of nerve compression, followed by deep tendinous fascia and anterior crural intermuscular septum. There was a significant postoperative improvement in the median postoperative ankle dorsiflexion and eversion grades and average postoperative functional (4, 5, and 2.38, respectively). Preoperative ankle eversion was significantly correlated with denervation status. Additionally, the devernation status on MRI was positively correlated with the outcome favorability. However, denervation atrophy led to a less favorable outcome. Conclusion : Among patients with intractable PICPNe despite conservative management, surgical intervention could clinically improve motor function and functional ability. Additionally, MRI examination of the affected muscle could help diagnose CPNe and assess the postoperative prognosis.

• Journal of Pharmacopuncture
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• v.12 no.2
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• pp.21-29
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• 2009

Objective : This study was carried to identify the anatomical component of FTMM(Foot Taeyang Meridian Muscle) in human lower limb, and further to help the accurate application to real acupuncture. Methods : FTM at the surface of the lower limb was labelled with latex. And cadaver was stripped off to demonstrate muscles, nerves and the others and to display the internal structures of FTMM, being divided into outer, middle, and inner layer. Results : FTMM in human lower limb is composed of muscles, nerves, ligaments etc. The internal composition of the FTMM in human lower limb are as follows : 1) Muscle : Gluteus maximus. biceps femoris, semitendinosus, gastrocnemius, triceps calf, fibularis brevis tendon, superior peroneal retinacula, calcaneofibular ligament, inferior extensor retinaculum, abductor digiti minimi, sheath of flexor tendon at outer layer, biceps femoris, semimembranosus, plantaris, soleus, posterior tibialis, fibularis brevis, extensor digitorum brevis, flexor digiti minimi at middle layer, and for the last time semimembranosus, adductor magnus, plantaris, popliteus, posterior tibialis, flexor hallucis longus, dorsal calcaneocuboidal ligament at inner layer. 2) Nerve : Inferior cluneal nerve, posterior femoral cutaneous n., sural cutaneous n., proper plantar branch of lateral plantar n. at outer layer, sciatic nerve, common peroneal n., medial sural cutaneous n., tibial n. at middle layer, and for the last time tibial nerve, flexor hallucis longus branch of tibial n. at inner layer. Conclusions : This study proves comparative differences from already established studies from the viewpoint of constituent elements of FTMM in the lower limb, and also in the aspect of substantial assay method. We can guess that there are conceptional differences between terms (that is, nerves which control muscles of FTMM and those which pass near by FTMM) in human anatomy.

• The Journal of Korean Medicine
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• v.32 no.3
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• pp.1-9
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• 2011

Objectives: This study was carried out to observe the foot gworeum meridian muscle from a viewpoint of human anatomy on the assumption that the meridian muscle system is basically matched to the meridian vessel system as a part of the meridian system, and further to support the accurate application of acupuncture in clinical practice. Methods: Meridian points corresponding to the foot gworeum meridian muscle at the body surface were labeled with latex, being based on Korean standard acupuncture point locations. In order to expose components related to the foot gworeum meridian muscle, the cadaver was then dissected, being respectively divided into superficial, middle, and deep layers while entering more deeply. Results: Anatomical components related to the foot gworeum meridian muscle in human are composed of muscles, fascia, ligament, nerves, etc. The anatomical components of the foot gworeum meridian muscle in cadaver are as follows: 1. Muscle: Dorsal pedis fascia, crural fascia, flexor digitorum (digit.) longus muscle (m.), soleus m., sartorius m., adductor longus m., and external abdominal oblique m. aponeurosis at the superficial layer, dorsal interosseous m. tendon (tend.), extensor (ext.) hallucis brevis m. tend., ext. hallucis longus m. tend., tibialis anterior m. tend., flexor digit. longus m., and internal abdominal oblique m. at the middle layer, and finally posterior tibialis m., gracilis m. tend., semitendinosus m. tend., semimembranosus m. tend., gastrocnemius m., adductor magnus m. tend., vastus medialis m., adductor brevis m., and intercostal m. at the deep layer. 2. Nerve: Dorsal digital branch (br.) of the deep peroneal nerve (n.), dorsal br. of the proper plantar digital n., medial br. of the deep peroneal n., saphenous n., infrapatellar br. of the saphenous n., cutaneous (cut.) br. of the obturator n., femoral br. of the genitofemoral n., anterior (ant.) cut. br. of the femoral n., ant. cut. br. of the iliohypogastric n., lateral cut. br. of the intercostal n. (T11), and lateral cut. br. of the intercostal n. (T6) at the superficial layer, saphenous n., ant. division of the obturator n., post. division of the obturator n., obturator n., ant. cut. br. of the intercostal n. (T11), and ant. cut. br. of the intercostal n. (T6) at the middle layer, and finally tibialis n. and articular br. of tibial n. at the deep layer. Conclusion: The meridian muscle system seemed to be closely matched to the meridian vessel system as a part of the meridian system. This study shows comparative differences from established studies on anatomical components related to the foot gworeum meridian muscle, and also from the methodical aspect of the analytic process. In addition, the human foot gworeum meridian muscle is composed of the proper muscles, and also may include the relevant nerves, but it is as questionable as ever, and we can guess that there are somewhat conceptual differences between terms (that is, nerves which control muscles in the foot gworeum meridian muscle and those which pass nearby) in human anatomy.

• Journal of Sasang Constitutional Medicine
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• v.21 no.1
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• pp.270-277
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• 2009

1. Objectives The purpose of this case study is to report the effects of Sukjiwhanggosam-tang which is based on the Sasang Constitutional Medicine for the Foot drop caused by peroneal nerve palsy. 2. Methods This patient was treated by Sukjiwhanggosam-tang according to the result of Sasang Constitutional diagnosis. We used Visual analogue scale(VAS), Range of motion(ROM) and Manual Muscle Testing(MMT) to evaluate the improvement of the Foot drop. 3. Results After 20 days treatment, the VAS of Rt. leg & foot hypoesthesia decreased from 10 to 2. The ROM of dorsiflexion of the ankle joint increased from $10^{\circ}$ to $30^{\circ}$ and the grade of MMT increased from 3 to 4. 4. Conclusions This case study shows an efficient result of using Sukjiwhanggosam-tang in the treatment of the Foot drop caused by peroneal nerve palsy.

• Journal of the Korean Burn Society
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• v.22 no.2
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• pp.58-65
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• 2019

Wound caused by high-tension electrical burns is difficult to manage because the wound is deep and complex. The wound is progressively necrotic due to microvascular injury resulting in deep tissue exposure. So, coverage of the wound at the entry point and the exit point is cumbersome, often requiring flap coverage. We experienced a case of one patient for peroneal artery perforator free flap coverage on the palm of the right hand of the entry point of electrical burn. The left foot wound of electrical exit point was covered by full thickness skin graft. Also a small wound was on the left side of the lower back was the exit point of electrical burn. The lower back wound was healed and recurred repeatedly after burn. On postburn day 6 month, through the radiologic exam, metal shadow was identified in the left gluteus muscle forming chronic sinus. We explored the wound of sinus and a foreign body was identified in the sac as multi braid wires thin as hair. According to the patient's past history, we suspected that the back wound was caused by electrical burn injury through the wires.