Cosmetic outcomes following head and neck melanoma reconstruction: The patient's perspective

Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, McMaster University, Hamilton, Ontario Correspondence: Dr Carolyn M Levis, Division of Plastic Surgery, Department of Surgery, St Joseph’s Healthcare, 50 Charlton Avenue East, Room G820, Hamilton, Ontario L8N 4A6. Telephone 905-522-1155 ext 34969, fax 905-525-6424, e-mail levisc@mcmaster.ca The common peroneal nerve (CPN) is the most commonly injured nerve in the lower limb. Injury to the CPN and, more specifically, the deep peroneal nerve (DPN), can lead to permanent weakness or paresis of toe and ankle dorsiflexors. Causes include trauma, dislocation, iatrogenic injury and peripheral nerve lesions (1). Patients experience difficulties with the swing phase of gait. To compensate, patients adopt a high stepping gait to lift the foot higher off the ground. These injuries can be treated nonoperatively using an anklefoot orthotic. It is known that an individual using an ankle-foot orthotic has a significantly lower quality of life in the domains of physical functioning, mental health, vitality, bodily pain and general health perception when compared with a patient without an impairment necessitating the device (2). Current surgical treatments include decompression at the fibular head for compressive palsies (3,4). Injuries that do not show signs of recovery require early nerve grafting to reconstruct the injured nerve segment with or without tendon transfers (5,6). Tendon transfers alone may also be performed depending on the duration of time since injury (7). However, for both of these procedures, functional outcomes are often poor compared with similar reconstructive procedures for other major nerves in the upper extremity. The current literature characterizes nerve transfers using expendable donor nerves in the lower limb as experimental or alternative surgical procedures, rather than as an accepted surgical option. The authors suggest that this may be a preferred treatment plan – over other traditional options – for several reasons. Nerve transfers minimize dissection and potential injury to surrounding tissues. They facilitate faster recovery because they can lead to more rapid reinnervation than nerve grafts due to the fact that the transferred axons are closer to the targeted motor end plates. In addition, nerve transfers avoid the problem of ‘missed zone of injury’ when using nerve grafts. This is of particular concern for the common peroneal nerve, which can suffer significant and widespread stretch in lateral knee injuries. originAl Article