The anatomy of the saphenous and sural nerves as a source of processed nerve allografts

Sural nerve injury risk during endoscopic gastrocnemius recession: Comparison of two approaches

BACKGROUNDS

The gastrocnemius recession was originally introduced as a method of treating isolated gastrocnemius contractures among pediatric population, however currently this procedure allows to treat various foot pathologies. Different modifications of open technique has been developed over the years and recently endoscopic approach become a widespread technique among many surgeons. It provides smaller incision and shorter operative time, however might be associated with the higher risk of sural nerve damage as a result of poor visualization. The aim of this study was to evaluate two different endoscopic approaches, introduced by Stryer and Lui, in terms of sural nerve injury.

METHOD

In 14 dissected legs the following measurements were assessed: 1) Distance between the sural nerve and cannula. 2) Distance to the sural nerve from the lateral portal and the medial portal when performing the Strayer technique. 3) Distance to the sural nerve from the lateral portal and the medial portal when performing the Lui technique.

RESULT

In both techniques the sural nerve was located dorsally to the cannula and no nerve damage was observed. In Lui technique the distance between cannula and the nerve was noticeably deeper than in Strayer method.

CONCLUSION

Both method of endoscopic gastrocnemius recession have similar risk of intraoperative sural nerve injury. Open method should always be considered as an alternative, especially for surgeons who lack experience in endoscopic procedures.

LEVEL OF EVIDENCE

II.

Anatomical patterns of the sural nerve: a meta-analysis with clinical and surgical considerations

BACKGROUND

The sural nerve (SN) supplies the posterolateral aspect of the leg and the lateral aspects of the ankle and foot and descends through the gastrocnemius muscle along the lower third of leg. Because in-depth knowledge about SN anatomy is essential for clinical and surgical approaches, our study aims to review SN anatomical patterns.

METHODS

We searched the PubMed, Lilacs, Web of Science, and SpringerLink databases to find relevant articles for meta-analysis. We assessed the quality of the studies using the Anatomical Quality Assessment tool. We used proportion meta-analysis to analyze the SN morphological variables and simple mean meta-analysis to analyze the SN morphometric variables (nerve length and distance to anatomical landmarks).

RESULTS

Thirty-six studies comprised this meta-analysis. Overall, Type 2A (63.68% [95% CI 42.36-82.64]), Type 1A (51.17% [95% CI 33.16-69.04]) and Type 1B (32.19% [95% CI 17.83-48.38]) were the most common SN formation patterns. The lower third of leg (42.40% [95% CI 32.24-52.86]) and middle third of leg (40.00% [95% CI 25.21-53.48]) were the most common SN formation sites. The pooled SN length from nerve formation to the lateral malleolus was 144.54 mm (95% CI 123.23-169.53) in adults, whereas the SN length was 25.10 mm (95% CI 23.20-27.16) in fetuses in the second trimester of gestation and 34.88 mm (95% CI 32.86-37.02) in fetuses in the third trimester of gestation.

CONCLUSIONS

The most prevalent SN formation pattern was the union of the medial sural cutaneous nerve with the lateral sural cutaneous nerve. We found differences regarding geographical subgroup and subject age. The most common SN formation sites were the lower and middle thirds of the leg.