Sural nerve harvest for infants: integrated with information based on anatomical dissections

Abstract

Background/aim: The aim of the present study was to determine the course and possible variations of the sural nerve with all anatomical details in human fetal cadavers. Materials and methods: This study was performed on 60 fetal cadavers. Formation type and level of the sural nerve was detected. Results: According to trimesters, it was determined that the mean transverse and vertical distance between the lowest point of the LM and the SN varied between 1.1-2.9 mm and 1.54-3.58 mm, respectively. Type 2 was the most common seen type of sural nerve (35,83%). It was determined that sural nerve was mostly formed at the middle third of the leg (42,5%). Conclusion: Sural nerve graft with the knowledge of the anatomical details may be used for peripheral nerve reconstruction is required in congenital lesions, such as facial paralysis, obstetric brachial paralysis, and post-traumatic lesions in infants and children.

Variations in sural nerve formation and course in fetuses

“…We found Type 4 in most of the lower limbs evaluated. Previous studies performed on fetuses corroborate this, as exempli ed by Büyükmumcu et al and Ulcay et al [4,29], which show a high prevalence of this anatomical pattern. Studies in adults have rati ed this information and set Type 4 as the classic pattern [1,5,6,14,17,23,31].…”

“…Type 6 was reported in all previous articles in both fetal and adult populations. This pattern was found in seven studies with Asian samples [10,12,14,17,24,26,31] and ve studies with Eurasian ethnicity, all from Turkey [1,2,4,7,29]. However, only three European studies showed Type 6 [15,21,28].…”

“…Uluutku et al stated that SN formation was most common in the middle third of the leg [30]. Büyükmumcu et al reported similar results [4]. Mestdagh et al [15] reported nerve branch communication more frequently in the distal half of the leg.…”

“…Surgeons recognize the SN and its components as ideal for grafting [24]. Using the SN graft in treating peripheral nerve injuries is broad for facial paralysis, post-obstetric brachial plexus palsy, and posttraumatic injuries [4,30]. Depending on anatomical variations, surgical procedures or incisions for reconstructions or repair of the CT, subtalar arthrodesis, and distal bula fractures [1] can injure the SN or its branches.…”

“…Sural nerve variations can cause inadequate stimulation of the nerve complex and misinterpretation of diagnoses in studies of nerve conduction and biopsies for diagnosing focal or generalized neuropathies of lower limbs [5,12]. The SN is the principal donor for nerve grafting in facial paralysis reconstruction, post-traumatic injuries, and post-obstetric brachial plexus paralysis [4,12].…”