Use of tibialis anterior muscle VDMT flip flap in transtibial amputation to prevent superficial peroneal nerve neuroma formation: a surgical technique description

Background. The formation of symptomatic stump neuromas is one of the most common complications after amputation. Symptomatic neuromas cause pain, which, in turn, reduces the quality of life and makes prothesis use complicated or even impossible. Neuroma development is a result of disorganized axonal growth due to the lack of a target for reinnervation. After transtibial amputation, neuromas most often growth from the superficial peroneal nerve (SPN), due to its anatomical location and function. The purpose was to substantiate and describe the novel surgical technique for prevention of SPN neuroma formation by creation a physiological target for reinnervation in the form of a vascularized denervated muscle target (VDMT) derived from the anterior tibial muscle during transtibial amputation. Materials and methods. The technique involves isolation of a vascularized denervated segment from the tibialis anterior muscle, taken from below the level of the planned transtibial amputation, further mobilization of the flap on the anterior tibial vessels, followed by proximal rotation and wrapping of transected SPN. Results. This technique creates a target for organized axonal regeneration of SPN and prevents symptomatic neuromas development. Our own clinical experience with this technique indicates a slight increase in the duration of the surgical intervention and the absence of specific complications. The proposed method allows for targeted prevention of the formation of symptomatic neuromas during transtibial amputation, especially for high-risk nerves, such as the SPN. Conclusions. The tibialis anterior VDMT flip flap technique during transtibial amputation is a promising method for preventing symptomatic superficial peroneal neuromas. If necessary, this method can be applied to other or multiple nerves. Further clinical studies are needed to evaluate long-term results.