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Diabetic peripheral neuropathy (DPN) complicated by plantar diabetic foot ulcers (DFUs) results from chronic nerve compression and autonomic dysfunction, leading to sensory loss and impaired perfusion. Standard ulcer-focused treatments do not address these neurovascular issues. The objective of this study is to evaluate the effectiveness of Dellon decompression of the tarsal tunnel in preventing recurrence and onset of new diabetic foot ulcers in patients with diabetic neuropathy.

A prospective cohort of 24 patients with type 2 diabetes, confirmed DPN, and plantar DFUs underwent Dellon decompression of the tarsal tunnel. Posterior tibial artery (PTA) diameter was assessed via Doppler ultrasonography at baseline, 9, and 18 months postoperatively. Sensory function in the medial plantar (MPN), lateral plantar (LPN), and calcaneal (CN) nerves was evaluated using two-point discrimination and Medical Research Council grading (TPD-MRC) at the same follow-up points. Contralateral limb served as an internal control. Paired t-tests were used for statistical analysis.

All patients achieved complete ulcer healing by 18 months, with no recurrence or new ulcer formation. PTA diameter increased significantly by 26% at 18 months (p = 0.028), indicating sustained vasodilatation. Sensory improvements were significant in the operated limb compared to the control: MPN (90.5%, p < 0.001), LPN (85.7%, p = 0.01), and CN (71.4%, p = 0.01). No wound infections or new ulcer formations were observed post-operatively.

In conclusion, decompression of the sympathetic fibers within the tibial nerve at the ankle can enhance blood flow in diabetic neuropathy. Dellon Decompression of the four medial ankle tunnels also improves wound healing in the foot's plantar area and emphasizes the crucial role of enhanced blood flow and sensibility in promoting ulcer healing in diabetic foot patients.

Schwannomas are heterogeneous peripheral nerve sheath tumors, diagnosed through clinical assessment, ultrasound (US) and MRI. The lack of standardized imaging criteria often leads to uncertainty, necessitating preoperative biopsies that may cause sensory-motor deficits.
The study aims to identify common preoperative US and MRI features schwannomas to help standardize imaging assessment.

We retrospectively reviewed histologically confirmed schwannomas treated at our institution from 2020 to 2025, analyzing preoperative US and, when available, MRI. US assessed nerve entry/exit, margin characteristics, mass position, fascicular structure, and intratumoral degenerative features. MRI features were assessed, including signal characteristics on T1- and T2-weighted sequences, appearance on fat-saturated T2 images, patterns of contrast enhancement, and the presence of characteristic signs (thin hyperintense rim, the target sign, or the split-fat sign).

32 histologically confirmed schwannomas were included in 19 men (65.6%) and 10 women (34.4%) with a mean age of 56 ± 15.5 years (range: 19–85 years).
Schwannomas were located on limbs (87.5%), trunk (6.25%), and the brachial plexus (6.25%). The most common nerve of origin was the tibial nerve and its branches (25%).
On US, an entering/exiting nerve was observed in 65.6% of cases. No fascicles were seen at the tumor center due to the displacing growth pattern. 71.4% of lesions were eccentric, and 28.6% were central to the nerve. Most tumors had clear margins (96.9%). Intratumoral cysts were present in 50.0% and degenerative features in 34.4%
On MRI, schwannomas were isointense on T1 sequences in 76% and hyperintense on T2 in 84% of cases. Diffuse homogeneous enhancement and T2 fat-saturated hyperintensity with homogeneity were seen in 52%. A thin hyperintense rim appeared in 44%, while the target sign and split-fat sign were present in 20% and 52%.
40.6% of cases underwent biopsy, carrying the risk of temporary sensory-motor deficits or pain.

US is a valuable, non-invasive tool for preoperative schwannoma evaluation, particularly for visualizing the entering and exiting nerve. MRI provides complementary, though nonspecific information, with T1 and T2 weighted signal characteristics enhancing diagnostic confidence in larger tumors in anatomically complex regions.

To evaluate the outcome of C7 to SSN nerve transfer in terms of degree of shoulder abduction and external rotation.

12 patients with a mean age of 29 years (range, 15 to 42 years) were operated on at a mean delay of 4 months after their trauma (range, 2 to 7 months). Patients had C5-C6 brachial plexus palsy with avulsed roots on magnetic resonance imaging scan. Along with the the partial C7 transfer, additional nerve transfers performed were medial branch of triceps to the axillary nerve and the motor branches of the ulnar & median nerve to branches of biceps and brachialis muscles.

At a mean follow-up of 24 months (range, 18 to 28 months), mean shoulder abduction and external rotation ranges of motion were, respectively, 94 degrees (range, 45 to 140 degrees ) and 46 degrees (range, 0 to 120 degrees ). In seven patients, shoulder abduction strength was graded M4 and in four patients was graded M3 . All patients had residual strength of the pectoralis major muscle M4+

C7 partial transfer to the suprascapular nerve showed satisfactory results at long-term follow-up for active shoulder abduction and external rotation recovery in C5-C6 brachial plexus palsies.

Parsonage-Turner Syndrome (PTS), also known as neuralgic amyotrophy, is an often-underdiagnosed neurological condition characterized by sudden-onset shoulder pain followed by selective muscle weakness and atrophy, typically affecting the long thoracic nerve (LTN) among others. While the lesion can usually be found in the proximal brachial plexus, surgical approaches such as neurolysis, resection, and direct nerve coaptation are often performed late due to delayed presentation and thus yield uncertain results. We aimed to evaluate distal thoracodorsal-to-long thoracic nerve transfer as a reconstructive strategy for restoring serratus anterior function in chronic PTS-associated scapular winging.

We present clinical cases of distal nerve transfer from a ventral motor branch of the thoracodorsal nerve (TDN) to the LTN in patients with longstanding scapula alata due to PTS. To further expand the translational scope of this work, we performed cadaveric dissections to assess anatomical feasibility and to define safe operative corridors, optimal arm positions for tension-free coaptation. Healthy cadaveric LTNs were analyzed by immunohistochemistry using choline acetyltransferase (ChAT) and neurofilament (NF) to establish normative axonal reference data. In one representative case, the same staining approach was applied to intraoperative donor and recipient nerve specimens to quantify motor and total axons.

Our results demonstrate consistent and rapid improvement in serratus anterior function, with all patients showing observable gains in muscle activation and scapular stability within a short period after surgery. Patients demonstrated marked improvement in shoulder function and scapular stability, with early clinical and surface EMG evidence of muscle reinnervation after the transfer. Cadaveric analysis confirmed anatomical feasibility and reproducible donor-recipient reachability under appropriate positioning. Histological evaluation provided normative axonal reference data and enabled comparison with intraoperative tissue.

Distal TDN-to-LTN nerve transfer appears to be a highly effective and anatomically validated strategy for selected patients with chronic PTS-associated scapular winging, offering targeted restoration of serratus anterior activation in a cohort in whom proximal reconstruction alone may yield inconsistent results.

Peripheral nerve injuries (PNIs) can result in significant motor and sensory deficits, often accompanied by neuropathic pain, leading to an impaired quality of life. While autologous non-vascularized nerve grafts (NVNGs) are widely regarded as the gold standard for nerve reconstruction, autologous free vascularized nerve grafts (VNGs) may offer superior outcomes in cases involving large nerve gaps or compromised wound beds. This study describes a single-center experience evaluating the surgical technique, patient characteristics, and clinical outcomes in peripheral nerve reconstruction using vascularized nerve grafts.

This retrospective case series included five adult patients who underwent peripheral nerve reconstruction using autologous free VNGs between January 2019 and September 2023, performed by a single surgeon. Data was extracted from electronic medical records, including patient demographics, injury characteristics, surgical details, and postoperative outcomes.

Five patients (four male, one female, median age 35 years) underwent vascularized nerve grafting for complex extremity nerve injuries (median gap 6 cm). Donor nerves included the sural nerve (n=4) and the medial brachial cutaneous nerve (n=1). All patients reported subjective improvement and high satisfaction. Improvement in sensory and motor function was observed in all cases. No complications occurred.

VNGs are safe and effective, with encouraging sensory and motor outcomes that appear to be non-inferior to conventional non-vascularized nerve grafts. This case series supports the feasibility and safety of autologous free VNGs for peripheral nerve reconstruction in the extremities. While limited by sample size, the subjective improvement in pain and function and consistent absence of complications underscore the potential clinical value of VNGs in select cases. Further studies with larger cohorts and standardized outcome measures are warranted to validate these findings.