Abstract
The utilization of nerve transfer procedures in the upper extremity following brachial plexus injury, trauma, spinal cord injury, tumors, infection, or other etiologies are well established. Nerve injuries in the lower extremity pose several additional challenges, including longer distance to target motor end plates, delayed presentation, and concomitant limb trauma. Nerve transfers in the lower extremity have the potential to provide functional (sensory or motor) recovery distally after direct surgical coaptation of a functional donor nerve to a non-functional recipient nerve. The ability to perform pure motor or sensory fascicular transfers allows for focused recovery while limiting donor morbidity. Indications for nerve transfers in the lower extremity are evolving, but transfers have been utilized for non-recovering peroneal, obturator, femoral, or tibial nerve palsies, to provide protective sensation to the plantar aspect of the foot as well as for painful neuropathies/neuromas. There is a paucity of orthopaedic literature on this topic and our review aims to highlight the current state of lower extremity nerve transfers as they relate to the practicing orthopaedist, including future directions in the field. KEY CONCEPTS: •Nerve transfers have been well-established as a treatment option for nerve injuries of the upper extremity and brachial plexus, but their use in the lower extremities is less common.•Nerve transfers may be of particular interest in the lower extremity because of the ability to cover relatively long distances as well as avoid the zone of injury, especially in far proximal injuries.•Nerve transfers of the lower extremity have been used to address motor deficit of the peroneal, femoral, obturator, and tibial nerves, as well as tibial and sural nerve sensory loss.•There is currently a paucity of orthopaedic literature on lower extremity nerve transfers and further understanding is required to better utilize these techniques to manage lower extremity peripheral nerve injury.