Calf-Contouring Surgery of Gastrocnemius Hypertrophy: Selective Neurectomy of the Sural Nerve

Abstract

Generally, Asians tend to have obese calves that are shorter and thicker than those of Caucasians. The cause of the enlarged calves is either an excess of subcutaneous fat or calf muscular hypertrophy, but some patients have both conditions. These features are accentuated by the contraction of the calf muscles when patients stand in tiptoe position or wear high heels. In the case of calf muscular hypertrophy without excessive subcutaneous fat, manipulation of the calf muscle is an effective method for reducing calf circumference. From January 2005 to December 2006, the authors performed selective sural neurectomy for 20 patients who complained of obese calves. Using a popliteal incision, the sural nerve branches to the medial and/or lateral gastrocnemius muscles were dissected from the posterior tibial nerve. Using a nerve stimulator, the branches with the most contractile portions were resected in 1 cm lengths at the distal ends. One medial branch was resected in 15 patients, and two branches were resected in 5 patients. In the case of a lateral neurectomy, only one branch was resected. Ultrasound-assisted liposuction was combined for five patients who also showed excessive subcutaneous fat. The patients ranged in age from 19 to 29 years (mean, 23 years). The follow-up period varied from 6 to 18 months. The circumferential change was checked 6 months postoperatively 15 cm below the medial condyle and 15 cm above the medial malleolus. These average circumferences were reduced, respectively, from 36.6 and 32.5 cm to 35.5 and 32.2 cm. In gait analysis performed at 6 months postoperatively, the calf muscle power was slightly reduced to 95% of the preoperative state, but still remained above the normal range. Subjectively, no patient complained of muscle weakness or gait disturbance. One patient showed lower leg edema after mountain climbing that subsided after 1 day of rest. The authors believe a selective neurectomy technique can be an effective method for treating obese calves.

Ankle Plantar-Flexion Contracture Complication After Aesthetic Calf Volume Reduction Procedure

“…Most studies that have reported favorable gait analysis results after calf volume reduction procedures, however, have been based on selective gastrocnemius denervation procedures. 6,9 Iatrogenic damage of the tibial nerve to the soleus may have been involved during the initial procedure, which is in proximity to branches to the gastrocnemius. 14 All in all, mild gait difficulties were evident in both Silfverskiöld testYnegative cases, although a plantigrade foot was achieved.…”

“…12,13 Published postoperative gait analysis results indeed show no significant functional deterioration after selective neurectomy. 6,9 Notable complications after selective neurectomy procedures are mostly transient, including temporary walking discomfort, transient numbness over the lateral ankle, and minor wound problems. 6,9 The possibility of iatrogenic nerve damage during selective neurectomy exists, as Hwang et al 14 reported the proximity of the common peroneal nerve to the tibial nerve entering the gastrocnemius muscle.…”

“…6,9 Notable complications after selective neurectomy procedures are mostly transient, including temporary walking discomfort, transient numbness over the lateral ankle, and minor wound problems. 6,9 The possibility of iatrogenic nerve damage during selective neurectomy exists, as Hwang et al 14 reported the proximity of the common peroneal nerve to the tibial nerve entering the gastrocnemius muscle. In general, minimally invasive calf reduction procedures are advertised as complication-free procedures to the public.…”

“…They include temporary walking discomfort, transient numbness over the lateral ankle, edema of the lower leg, hematoma, and wound dehiscence. 6,9 To the best of our knowledge, however, there are very few reports of permanent complications requiring medical attention after this procedure. We have experienced patients who had sustained severe standing and walking disturbances due to ankle planter f lexion contracture after aesthetic calf volume reduction procedures.…”

“…Previous articles report a 1-to 4.6-cm reduction of calf circumference as early as 6 months after the operation with minimal functional deterioration of the lower leg. 6,9 Reported complications of selective neurectomy are usually minor and transient. They include temporary walking discomfort, transient numbness over the lateral ankle, edema of the lower leg, hematoma, and wound dehiscence.…”