Safe Resection of Sciatic Neuroma and Reconstruction of the Tibial and Common Peroneal Nerves Using Autologous Sural Nerve Graft: Operative Video.

Sciatic nerve injuries result in profound motor and sensory deficits, and when direct repair is not feasible, autologous sural nerve grafting remains the gold standard for reconstruction. In this context, distal sciatic neuroma excision followed by sural nerve autografting illustrates the surgical nuances and technical challenges of bridging large distal nerve gaps. The procedure involves careful neuroma excision and reconstruction of the tibial and peroneal divisions using multiple reversed sural nerve cable grafts, with tension-free epineural coaptation performed under magnification to optimize outcomes. Although long grafts are associated with limited recovery, meticulous microsurgical technique and prioritization of the tibial division can enable meaningful functional restoration. Thus, autologous sural nerve grafting continues to provide a practical and viable solution for complex sciatic defects, underscoring its role in challenging reconstructions.