Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Abstract

Background The sural nerve is the most frequently harvested nerve autograft and is most often biopsied in the workup of peripheral neuropathy. While the complication types associated with these two procedures are well known, their clinical significance is poorly understood and there is a paucity of data regarding the complication rates. Methods Pubmed search identified studies regarding complications after sural nerve harvest and biopsy. The data was grouped into sensory deficits, chronic pain, sensory symptoms, wound infections, wound complications, other postoperative complications, and complications impacting daily life. The incidence of each complication was calculated, and a chi‐square analysis was performed to determine if there were any differences between nerve biopsies and graft harvest with respect to each complication. Results Twelve studies yielded 478 sural nerve procedures. Sensory deficits occurred at a rate of 92.9%, chronic pain at 19.7%, sensory symptoms at 41.1%, wound infections at 5.7%, noninfectious wound complications at 7.8%, and impact on daily life at 5.0%. The differences in wound infections, sensory symptoms, and impact on daily life between biopsies versus graft excisions were found to reach statistical significance (p < .05). Conclusions Sural nerve excisions can cause chronic postoperative donor‐site complications. Given these complications, alternative available mediums for nerve reconstruction should be explored and utilized wherever appropriate. If an alternative medium is unavailable and nerve autograft must be harvested for nerve reconstruction, then patients should be counseled about risks for developing donor site complications that may negatively affect quality of life.

Typical and atypical properties of peripheral nerve allografts enable novel strategies to repair segmental-loss injuries

“…The most significant clinical problem with repair/reconstruction of PNIs is the unavoidable WD that dooms the injured recipient to a slow and incomplete nerve regenerative process and often results in significant muscle atrophy and even permanent loss of NMJs, temporary or permanent loss of protective sensation, and profound functional/voluntary behavioral disabilities [ 171 , 172 ]. Autograft reconstruction of segmental-loss PNIs require that some level of further impairment is created by taking functional nerves from a region of lesser importance to rebuild those of greater importance [ 173 ]. Not only does this create an iatrogenic deficit that is typically sensory, since those are considered the most expendable nerve donors, but also may further impair nerve regeneration by providing only sensory-type Schwann cells with may provide less regenerative capacity for motor axons resulting in poorer motor recovery [ 174 , 175 ].…”

Reconstruction of Critical Nerve Defects Using Allogenic Nerve Tissue: A Review of Current Approaches

“…In clinical settings the use of cadaveric processed nerve graft or artificial nerve graft is beneficial for patients to avoid donor side morbidity or offers new reconstructive perspectives in cases where donor nerves are not available or limited [ 11 , 87 , 88 ]. Further, a minor, but important share of trauma patients suffers from multiple nerve lesions as well as patients with various types of neurofibromatosis [ 4 , 89 , 90 ].…”

Nerve Cable Graft Interposition in Patients with Brachial Plexus Schwannoma: Case Reports

“…Similar to the HB grade of the facial nerve, nerve injury recovery was ob- JCS served (i.e., the MRC score increased). The representative postoperative complications after nerve graft interposition reported in several studies can be classified into 5 categories: sensory deficits, chronic pain, sensory symptoms (tingling, cold intolerance, paresthesia, or an irritating sensation), wound infection, and wound complications (hypertrophic scar, poor cosmesis, or wound dehiscence) [5,6]. In our cases, although a hypertrophic scar was observed in the first patient, no other significant complications that could affect daily life were reported in any of the 3 cases.…”