Cadaveric Anatomical Study of Sural Nerve: Where is The Safe Area for Endoscopic Gastrocnemius Recession?

Tan, Alvin Chin Kwong; Tang, Zhi Hao; Fadil, Muhammad Farhan Bin Mohd

doi:10.2174/1874325001711011094

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Other anatomical studies published in 2007 and 2008 by Blitz et al showed the high variability of the location of the fusion of the two aponeuroses (conjoint junction) [ 7 , 8 ], leading the Strayer technique to a possible aspecific aponeurosis release of both the gastrocnemius and of the soleus aponeurosis, theoretically producing the risk of a complete detachment of the gastrocnemius with the risk of a complete consequent muscular atrophy and loss of function [ 7 , 8 ]. Moreover, during the Strayer procedure all surgical instruments are far between the sural nerve and his accompanying lesser saphenous vein, existing in tremendous anatomical variations [ 23 , 28 ], enhancing the risk of neurovascular injuries [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, either for the open and the endoscopic GIAR procedure there have been described some saphenous nerve and/or great saphenous vein damages despite their constant anatomy, leading to complications [ 28 ]. Performing the endoscopic GIAR in obese patients showed that in some cases the interval between the gastrocnemius and soleus muscles is difficult to identify, leading the surgeon to widen the portal to ensure the correct surgical spot, losing the “minimally invasive” intention [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis

et al. 2020

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Background The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the “GIAR”- technique: the gastrocnemius-intramuscular aponeurosis release. Methods and results An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6 years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2 mm (± 1 mm). The mean gain at the ankle joint ROM after the GIAR was 7.9° (± 1.1°). No damages of important anatomical structures could be found. Conclusion Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis

et al. 2020

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“…31 The site where the sural nerve courses laterally at the mid-fibula level is approximately 10 cm proximal to the calcaneal tuberosity. 39 Hoefnagels et al propose to do the gastrocnemius recession proximally as the sural nerve is protected by the lateral head of gastrocnemius muscle. 31 Nonetheless, injury to the sural nerve is still possible due to the transverse incision made for gastrocnemius recession.…”

Section: Novel Technique Of Gastrocnemius Recessionmentioning

confidence: 99%

A novel technique of isolated gastrocnemius recession: A cadaveric comparison with Strayer procedure

Kow

Che-Ahmad

Ayeop

et al. 2021

J Orthop Surg (Hong Kong)

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Background Strayer’s gastrocnemius recession is a common technique in treating ankle equinus of gastrocnemius origin. Nevertheless, this technique is associated with a few flaws. We aim to introduce a novel technique of isolated gastrocnemius recession and perform a cadaveric study to evaluate its safety and at the same time compare this novel technique with the existing Strayer procedure biomechanically. Methods Eight fresh cadaveric models of gastrocnemius tightness were established by isolated traction of the gastrocnemius muscles. Gastrocnemius recession was performed on all eight models with Strayer method and the novel method randomized equally. The safety of both the techniques was evaluated by identifying any iatrogenic injury to the surrounding structures. The lengthening and improvement of the ankle dorsiflexion was measured and compared between the two techniques. Results There was no iatrogenic sural nerve or saphenous vein injury in all eight models. There was no significant difference between the two techniques in terms of lengthening (24.25 mm vs 21.00 mm; p = 0.838) and improvement of ankle dorsiflexion (26.5° vs 26°; p = .829). Conclusions Both Strayer technique and the novel technique of gastrocnemius recession lengthened the gastrocnemius and improved the ankle dorsiflexion in this cadaver trial. Both procedures were safe with proper techniques, and there was no significant difference in efficacy between them. Level of Evidence Level II, randomized controlled trial.

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“…Endoscopic gastrocnemius recession appears to be less invasive and may have advantages over open procedures in terms of skin damage, smaller incisions, shorter recovery times, fewer complications, and reduced morbidity [28], although sural nerve injury and the need for limb exsanguination may be limitations [29].…”

Section: Introductionmentioning

confidence: 99%

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

Marcos¹,

Martínez²,

Díaz³

2022

J Orthop Surg Res

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Background Gastrocnemius tendon lengthening is performed to treat numerous conditions of the foot and ankle. Gastrocnemius shortening has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flat foot deformity, and metatarsalgia. Ultrasound-guided ultraminimally invasive lengthening of the gastrocnemius is a step forward in this type of surgery. It can be performed in both legs simultaneously without ischemia using only local anesthesia plus sedation and without the need for a cast or immobilization. The truly novel advantage of the procedure is that it can be performed in the office, without specific surgical instruments. The aim of our research was to prove the effectiveness and safety of a new closed needle-based ultrasound-guided surgical procedure for lengthening the gastrocnemius tendon. Methods and results We performed ultrasound-guided gastrocnemius tendon lengthening using a needle in eight fresh frozen specimens (3 left and 5 right). None of the specimens had been affected by disease or undergone previous surgery that could have affected the surgical technique. We used a linear transducer with an 8- to 17-MHz linear transducer and the beveled tip of an Abbocath as a surgical blade to perform the lengthening procedure. The gastrocnemius Achilles tendon recession was entirely transected in all eight specimens, with no damage to the sural nerve or vessels. The improvement in dorsal flexion was 15°. Conclusion Needle-based ultrasound-guided gastrocnemius tendon lengthening is safe, since the surgeon can see all structures clearly, thus minimizing the risk of damage. The absence of a wound obviates the need for stitches, and recovery seems to be faster. The procedure can be performed in a specialist's office, as no specific surgical instruments are required. This technique could be a valid option for gastrocnemius lengthening and may even be less traumatic than using a hook-knife, as in our previous description.

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Cadaveric Anatomical Study of Sural Nerve: Where is The Safe Area for Endoscopic Gastrocnemius Recession?

Cited by 8 publications

References 11 publications

Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis

Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis

A novel technique of isolated gastrocnemius recession: A cadaveric comparison with Strayer procedure

Needle-based gastrocnemius lengthening: a novel ultrasound-guided noninvasive technique

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