Study of Sural Nerve Complex in Human Cadavers

Aim. The sural nerve complex (SNC) consists of four named components: medial sural cutaneous nerve (MSCN), lateral sural cutaneous nerve (LSCN), peroneal communicating nerve (PCN), and sural nerve (SN). The formation and distribution of the sural nerve vary in different individuals. SN is universally recognized by surgeons as a site for harvesting an autologous nerve graft. The nerve is widely used for electrophysiological studies. Hence the study of sural nerve complex was taken up. Method. SNC was observed by dissecting 100 lower limbs in the department of anatomy at three different medical colleges, over a period of 10 years. Result. Typical SN was observed in 60% of the cases. MSCN was present in all the cases; in 15% of the cases the MSCN followed an intramural course. LSCN was present in 80% of the cases. PCN was present in 70% of the cases and in most of the cases calibre was larger than that of MSCN. Conclusion. The knowledge about the variation in the origin and course of the SN is important in evaluating sensory axonal loss in distal axonal neuropathies and should be borne in mind by clinicians and surgeons.

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Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01974-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hamid Namazi ◽

Ahmad Sobhani ◽

Saeed Gholamzadeh ◽

Amirreza Dehghanian ◽

Fatemeh Dehghani Nazhvani

Keyword(s):

Surface Area ◽

Sural Nerve ◽

Nerve Graft ◽

Cutaneous Nerve ◽

Digital Nerve ◽

Cross Sectional ◽

Nerve Grafts ◽

Anterior Interosseous Nerve ◽

The Mean ◽

Graft Selection

Abstract Background Even though several studies reported donor autologous nerve grafts for digital nerve defects, there is no report in the literature regarding acceptable graft for thumb nerves. The purpose of this study is to provide guidelines for autologous nerve graft selection by detecting similarities between thumb nerve zones and donor nerve with regard to the number of fascicles and cross-sectional area. Materials and methods Five cadavers were used in this study. An anatomical zoning system was defined for thumb nerves (zones 1, 2, 3). Sural nerve (SN), medial antebrachial cutaneous nerve (MABCN), lateral antebrachial cutaneous nerve (LABCN), posterior interosseous nerve (PIN), and anterior interosseous nerve (AIN) were selected as donor nerve grafts. The number of fascicles and surface area (mm2) was defined. Results The mean of the fascicle number in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 3.8, 4.7, 6.1, 2.2, 1.8, 4.5, 3.1, and 6.4, respectively. The mean of the surface area in zone 1, zone 2, zone 3, AIN, PIN, LABCN, MABCN, and SN were 2.19, 6.26, 4.04, 1.58, 0.71, 5.00, 3.01, and 8.06, respectively. Conclusions LABCN is the best choice for all zones that has fascicular matching with all three zones of thumb nerves and caliber matching with zones 2 and 3. In zone 1, the best nerve graft is MABCN which has both suitable caliber and fascicle count.

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The Anatomic Features of the Sural Nerve With an Emphasis on its Clinical Importance

Foot & Ankle International ◽

10.1177/107110070502600712 ◽

2005 ◽

Vol 26 (7) ◽

pp. 560-567 ◽

Cited By ~ 48

Author(s):

'Z. Asli Aktan iKiZ ◽

Hülya üÇerler ◽

Okan Bilge

Keyword(s):

Sural Nerve ◽

Clinical Importance ◽

Lateral Malleolus ◽

Lower Limbs ◽

Cutaneous Nerve ◽

Lateral Side ◽

Fifth Toe ◽

The Mean ◽

Clinically Significant ◽

Lateral Cutaneous Nerve

Background: The sural nerve is formed by the union of the medial and lateral cutaneous nerves of the leg that originate from the tibial and common peroneal nerves. Operative procedures and traumatic injuries to the popliteal fossa, leg, ankle and foot place the sural nerve and its branches at risk. The aim of this study was to describe the course, variations and some clinically significant relations of the sural nerve. Methods: The sural nerve was dissected in 30 lower limbs (leg-ankle-foot) of 15 cadavers. The specimens were measured, drawn and photographed. Results: In 18 specimens (60%) the sural nerve originated from the union of the medial and lateral cutaneous nerves of the leg in the upper two-thirds of the leg (classic type). The union of the medial and lateral cutaneous branches was in the distal third of the leg in three specimens (10%). The lateral cutaneous nerve was absent in five (16.7%), and the medial cutaneous nerve was absent in 2 (6.7%) specimens. In two specimens (6.7%) the nerves had separate courses. The mean distance between the most prominent part of the lateral malleolus and the sural nerve was 12.76 ± 8.79 mm. The mean distance between the tip of the lateral malleolus and sural nerve was 13.15 ± 6.88 mm. The most common distribution of the sural nerve in the foot was to the lateral side of the fifth toe (60%), followed by the lateral two and a half toes (26.7%). Conclusions: These described variations and measurements should be helpful for planning operative approaches that minimize the risk of sural nerve injury.

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Unusual anatomical variation in formation of sural nerve

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v18i3.41618 ◽

2019 ◽

Vol 18 (3) ◽

pp. 508-512

Author(s):

Humberto Ferreira Arquez

Keyword(s):

Lower Limb ◽

Sural Nerve ◽

Peroneal Nerve ◽

Tibial Nerve ◽

Anatomical Variation ◽

Medical Science ◽

Common Peroneal Nerve ◽

Clinical Findings ◽

Lower Limbs ◽

Cutaneous Nerve

Background: Sural nerve is formed by communication of medial sural cutaneous nerve, that arise from tibial nerve in popliteal fossa and peroneal communicating nerve, a branch directly from common peroneal nerve or from lateral sural cutaneous nerve.The objective of this study was described an unusual and few reported anatomical variation in formation of sural nerve. Materials and Methods: The anatomical variation described was found during routine dissection performed by medical students of second semester in two maleembalbed adult cadavers of 75 and 65 years of age, respectivelyin the laboratory of Morphology of the University of Pamplona. Results and Discussion: In the left lower limb, both medial sural cutaneous nerve, and lateral sural cutaneous nervewere absent. The sural nerve arose directly from the tibial nerve. It’s observed a communicating branch between tibial nerve and common peroneal nerve. In the right lower limb, lateral sural cutaneous nerve was absent. The sural nerve arose directly from the common peroneal nerve.Peroneal communicating nerve was considered as absent in the two cases.Motor fiber from sural nerve to gastrocnemius muscle was observed in both lower limbs Conclusions:The knowledge of the sural nerve (normal anatomy and variations in origin and course) is important in evaluating of the patients, as well explaining the different clinical findings necessary for accuracy treatment. Bangladesh Journal of Medical Science Vol.18(3) 2019 p.508-512

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Transmuscular Course of the Medial Sural Cutaneous Nerve and its Clinical Implications

International Journal of Medical and Dental Sciences ◽

10.19056/ijmdsjssmes/2014/v3i1/80712 ◽

2014 ◽

Vol 3 (1) ◽

pp. 348

Author(s):

Sherry Sharma ◽

Tripta Sharma ◽

Sunil Bhardwaj

Keyword(s):

Sural Nerve ◽

Anatomical Variation ◽

Clinical Importance ◽

Anatomical Variations ◽

Cutaneous Nerve ◽

Clinical Implications ◽

Axonal Loss ◽

Adequate Knowledge

Variations of nerve are not only of anatomic and embryological interest but also of clinical importance. Their adequate knowledge will help in increasing surgical precision and decreasing morbidity. Anatomical variations in the formation of the sural nerve are common, although the topographical localization of this nerve is constant. In this report, we describe a case of an anomalous course of the medial sural cutaneous nerve which descended through the gastrocnemius via a tunnel formed within the muscle. Such anatomical variation of the sural nerve is clinically important when evaluating sensory axonal loss in distal axonal neuropathies since sural nerve mononeuropathy is less likely to occur.

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Reversal of thoracic sympathectomy through robot‐assisted microsurgical sympathetic trunk reconstruction with sural nerve graft and additional end‐to‐side coaptation of the intercostal nerves: A case report

Microsurgery ◽

10.1002/micr.30787 ◽

2021 ◽

Author(s):

Tommy Nai‐Jen Chang ◽

Bassem W. Daniel ◽

Angela Ting‐Wei Hsu ◽

Lisa Wen‐Yu Chen ◽

Cheyenne Wei‐Hsuan Sung ◽

...

Keyword(s):

Case Report ◽

Sural Nerve ◽

Nerve Graft ◽

Sympathetic Trunk ◽

Robot Assisted ◽

Thoracic Sympathectomy ◽

Intercostal Nerves ◽

Sural Nerve Graft

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The Vascularized Lateral Antebrachial Cutaneous Nerve Graft Based on a Radial Artery Perforator for Nerve Defect Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000001856 ◽

2016 ◽

Vol 137 (1) ◽

pp. 256e-257e

Author(s):

Olivier Camuzard ◽

Rémi Foissac ◽

Patrick Baqué ◽

Nicolas Bronsard ◽

Charalambos Georgiou

Keyword(s):

Radial Artery ◽

Nerve Graft ◽

Cutaneous Nerve ◽

Defect Reconstruction ◽

Artery Perforator

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Implantation of autologous peripheral nerve grafts into the substantia nigra of subjects with idiopathic Parkinson's disease treated with bilateral STN DBS: a report of safety and feasibility

Journal of Neurosurgery ◽

10.3171/2016.2.jns151988 ◽

2017 ◽

Vol 126 (4) ◽

pp. 1140-1147 ◽

Cited By ~ 7

Author(s):

Craig G. van Horne ◽

Jorge E. Quintero ◽

Julie A. Gurwell ◽

Renee P. Wagner ◽

John T. Slevin ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Substantia Nigra ◽

Peripheral Nerve ◽

Neurotrophic Factors ◽

Sural Nerve ◽

Cell Function ◽

Nerve Graft ◽

Clinical Trial Registration ◽

Peripheral Nerve Graft

OBJECTIVE One avenue of intense efforts to treat Parkinson's disease (PD) involves the delivery of neurotrophic factors to restore dopaminergic cell function. A source of neurotrophic factors that could be used is the Schwann cell from the peripheral nervous system. The authors have begun an open-label safety study to examine the safety and feasibility of implanting an autologous peripheral nerve graft into the substantia nigra of PD patients undergoing deep brain stimulation (DBS) surgery. METHODS Multistage DBS surgery targeting the subthalamic nucleus was performed using standard procedures in 8 study participants. After the DBS leads were implanted, a section of sural nerve containing Schwann cells was excised and unilaterally delivered into the area of the substantia nigra. Adverse events were continuously monitored. RESULTS Eight of 8 participants were implanted with DBS systems and grafts. Adverse event profiles were comparable to those of standard DBS surgery. Postoperative MR images did not reveal edema, hemorrhage, or significant signal changes in the graft target region. Three participants reported a patch of numbness on the outside of the foot below the sural nerve harvest site. CONCLUSIONS Based on the safety outcome of the procedure, targeted peripheral nerve graft delivery to the substantia nigra at the time of DBS surgery is feasible and may provide a means to deliver neurorestorative therapy. Clinical trial registration no.: NCT01833364 (clinicaltrials.gov)

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Anatomy of the sural nerve and its relation to the Achilles Tendon

Foot & Ankle International ◽

10.1177/107110070002100604 ◽

2000 ◽

Vol 21 (6) ◽

pp. 475-477 ◽

Cited By ~ 142

Author(s):

Jonathan Webb ◽

Narain Moorjani ◽

Mike Radford

Keyword(s):

Achilles Tendon ◽

Nerve Injury ◽

Individual Variation ◽

Sural Nerve ◽

Proximal Part ◽

Lower Limbs ◽

Lateral Border

Sural nerve injury is a complication of Achilles Tendon (TA) rupture. We dissected 30 cadaveric lower limbs to describe the course of the sural nerve in relation to the TA. At the level of insertion of the TA into the calcaneum, the sural nerve was a mean 18.8 mm from the lateral border of the TA. The proximal course of the nerve was towards the midline such that it crossed the lateral border of the TA at a mean distance of 9.8 cm from the calcaneum. The significant individual variation in the position of the sural nerve in relation to the achilles tendon should be borne in mind when placing sutures in the proximal part of the achilles tendon. Percutaneous sutures should not be placed in the lateral half of the TA.

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