Safe Resection of Common Peroneal Neuroma with Direct Autologous Tibial Nerve Fascicle Transfer: Case Report and Operative Video

Foot drop from common peroneal nerve (CPN) injury yields poor outcomes with long-segment grafting for defects >6 cm. Distal tibial fascicle transfers offer a promising alternative. This report describes safe CPN neuroma resection and reconstruction via direct autologous tibial fascicle transfer. A 31-year-old male with right foot drop underwent neuroma excision at the sciatic bifurcation. Autologous tibial nerve fascicles from gastrocnemius muscular branches were coapted end-to-end with 10-0 nylon to both peroneal divisions under magnification. At 3-year follow-up, the patient had persistent foot drop with marked distal limb wasting, consistent with published poor recovery rates (63-72%) in lower extremity nerve repairs. Tibial fascicle transfer is a safe, effective alternative to conventional grafting in high CPN injuries. Early intervention, careful donor selection, and structured rehabilitation are critical for optimizing outcomes.