Sihler's staining of the cutaneous nerves of the leg and its implications for sensory reconstruction

Abstract

Introduction This study aimed to reveal the entire cutaneous nerve distribution pattern of the leg and provide a morphological basis for sensory reconstruction during skin flap transplantation. Materials and Methods Twelve adult cadavers were fixed with formalin, and the whole leg skin with subcutaneous fat was removed close to the muscle surface. The cutaneous nerves were visualized using modified Sihler's staining to reveal the distribution and innervation density of the cutaneous nerves. Results The saphenous nerve innervated the anterior part, 82.2% of the upper‐middle region of the lateral part of the anterolateral leg, and the upper 63.4% of the medial posterior leg. The superficial peroneal nerve innervated 90.1% of the lateral lower one‐third of the anterolateral leg. The medial sural cutaneous nerve covered 26.4% of the posterior leg. The lateral sural cutaneous nerve covered 42.3% (approximately 28.6% overlap with the saphenous nerve) of the upper‐middle region of the anterolateral and posterolateral leg. The number of branches differed between certain cutaneous nerves in the leg. Communications were observed between the arborizations of the four cutaneous nerves mentioned above. The highest density of primary and secondary nerve branches was observed in the upper one‐third of the lateral posterior leg. The upper one‐third of the posteromedial leg contained the highest density of intracutaneous nerve branches and highest number of total nerve branches. Conclusions These results may be used to map sensory regions when designing leg skin flaps for reconstruction surgery to obtain improved sensory recovery.

Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study

“…The risk of damage to cutaneous nerves are part of iatrogenic complications in surgical approaches [ 43 ] and are often underdiagnosed [ 44 ]. In the Luo and traditional Lobenhoffer approaches, owing to a more medial incision, the saphenous nerve can potentially be damaged [ 3 , 10 , 44 , 45 ]. In contrast, Van den Berg et al.…”

“…The MSCN is the most medial structure of the sural nerve complex [ 46 ]. While the lateral sural cutaneous nerve has a variable origin and course, and even bifurcating branches [ 45 , 47 ], the MSCN is normally located at the posterior midline under the SSV at the level of the knee joint [ 36 , 46 ]. Distally, at or under the level of the fibular head, the MSCN can be found in the posterior midline, slightly lateral or usually slightly medial [ 45 , 46 ].…”

“…While the lateral sural cutaneous nerve has a variable origin and course, and even bifurcating branches [ 45 , 47 ], the MSCN is normally located at the posterior midline under the SSV at the level of the knee joint [ 36 , 46 ]. Distally, at or under the level of the fibular head, the MSCN can be found in the posterior midline, slightly lateral or usually slightly medial [ 45 , 46 ]. In relation to this, we assume this possible medial path as the ‘theorical path’, which represents the most lateral limit for our skin and fascia incision (Figs.…”

Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies

“…[11][12][13]15 We recommend that the findings by Jaspars et al regarding which cutaneous nerve branches supply the largest surface area of the breast be confirmed using methods more feasible for tracing fine terminal nerve branches than classic anatomical dissection. 35,36 The course and trajectory of dominant nerve branches require further investigation through three-dimensional visualization or reconstruction of nerves in vivo 37 and/or in cadaveric breasts. 38 Anatomical variation between ethnic subgroups and intrapopulation variation also require exploration.…”