Postoperative neuralgia in the leg after saphenous vein coronary artery bypass graft: a prospective study.

Abstract

The degree of cutaneous sensory deficit in the leg was assessed after removal of the long saphenous vein in 50 consecutive patients undergoing coronary artery bypass vein grafts randomly assigned subcutanous sutures or a single layer of sutures. Removal of the vein and repair of the leg incision were done by the same team of surgeons. In group 1 (25 patients) the leg incision was repaired with "00" Dexon subcutaneous and "00" prolene subcuticular sutures while in group 2 (25 patients) closure was effected by a single layer of interrupted "00" nylon sutures. All had crepe pressure bandage from the base of the toes to the groin for the first 24 hours followed by TED stockings for six to eight weeks. Sutures were removed on the eighth postoperative day. Cutaneous sensation in the leg and ankle was assessed 48 hours, seven days, and six to eight weeks after surgery, and a final comparison of the cosmetic effects and sensory perception after one year or more was made in 37 patients. There were no major differences between the groups at 48 hours in sensory abnormalities (anaesthesia, hyperaesthesia, and pain) but sensory recovery was significantly better in group 2 at the second and third assessments. There was some reduction in sensory abnormalities at the final review in group 1. No appreciable difference was noted in the quality of the scar between the two groups. We conclude that cutaneous sensation is better preserved by repairing the leg incision in a single layer. Subcutaneous sutures may produce neuropraxia of the long saphenous nerve by direct pressure as healing progresses.

Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein

“…Nair et al (1988) performed a prospective study looking at suture techniques and its affect on postoperative neuralgia. They assigned patients to either subcutaneous and subcuticular sutures or simple interrupted sutures for closure of the leg wound.…”

Endoscopic saphenous vein harvesting for coronary artery bypass grafting. Postoperative and mid-term outcome in a group of 100 patients

“…(4,6,14) Dobfie je znám i vztah mezi v˘skytem neurologick˘ch komplikací a technikou uzávûru incize. (4,15) EVH umoÏÀuje provést odbûr prakticky z jedná incize potfiebné k zavedení endoskopu. Po fázi uvolnûní kmene VSM tupou disekcí jsou postranní vûtve uzavírány hemoklipy, bipolární koagulací ãi pomocí harmonického skalpelu.…”

The Risk Factors Affecting the Complications of Saphenous Vein Graft Harvesting in Aortocoronary Bypass Surgery

“…This may be due to the design of our study. Nair et al (1988) used a similar technique for wound closure after saphenectomy and reported the prevalence of pain and tingling as 62%. We found the prevalence of these complications as 56%.…”