Surgical Anatomy of the Saphenous Nerve

Dayan, Víctor; Cura, Leandro; Cubas, Santiago; Carriquiry, Guillermo

doi:10.1016/j.athoracsur.2007.11.032

Cited by 39 publications

(36 citation statements)

References 3 publications

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“…Three further cadaveric studies (Murakami et al,1994; Dayan et al,2008 ; Veverková et al,2011) also described an adherence of the saphenous nerve to the great saphenous vein, by a common fascia at the distal part of the leg and the present study further supports this finding. The cadaveric study by Dayan and colleagues on 20 lower limb samples, found three consistent branches of the saphenous nerve during the course of travel through the leg (Dayan et al,2008). The current study suggests that branching of the saphenous nerve within the leg is not consistently presented as three branches with a greater variance of the branching patterns of the saphenous nerve apparent.…”

Section: Discussionsupporting

confidence: 86%

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

Wilmot

Evans

2012

Clinical Anatomy

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Saphenous donor site neuralgia is a cause of morbidity post-coronary artery bypass surgery. Saphenous nerve damage during harvesting of the great saphenous vein is thought to be responsible. We dissected 37 cadaveric lower limbs from the knee fold to the dorsal venous arches, to study the spatial relations of the saphenous nerve and great saphenous vein to identify its distribution within the leg. Distribution of the saphenous nerve was categorized into Type A, where the nerve traveled inferiorly and split into an anterior and posterior branch during its course between the knee fold and medial malleolus, Type B, where the nerve traveled anterior to the vein with a small caliber branch traveling posteriorly at the proximal end, Type C where two main branches originated at the knee fold, one anterior to and one posterior to the vein. Overall the vein and nerve crossed in 27 out of the 37 cases (73%), occurring between 5 and 29 cm from the malleolus (60% occurred between 16 and 26 cm). In 32 (86%) of cases, the distal part of the nerve and vein were tightly adhered to each other within a common sheath. The length of adherence ranged from 3 to 26 cm with an average of 14 cm. The saphenous nerve is highly vulnerable during harvesting of the great saphenous vein due to its close relationship and crossing branches. Knowledge of the distribution categories of the nerve can help guide the surgeon to avoid damaging nerve branches during harvesting.

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Section: Discussionsupporting

confidence: 86%

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

Wilmot

Evans

2012

Clinical Anatomy

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“…The saphenous nerve then descends along the medial tibial border with the long saphenous vein, giving cutaneous branches to the medial aspect of the leg, ankle, and forefoot and articular branches to the ankle joint. [15][16][17] The advantages of saphenous nerve block at the adductor canal are the presence of a clearly identifiable surrogate marker, the SFA, and greater potential for direct nerve imaging by ultrasound. 10,12 We think it likely that both factors contributed to the greater success rate and the faster onset of the saphenous nerve block at the adductor canal.…”

Section: Discussionmentioning

confidence: 99%

“…The course of the saphenous nerve can be variable in the lower thigh after it exits the adductor canal and splits to the infrapatellar and sartorial branches. [15][16][17] In 2 of the failures of the distal transsartorial group, the infrapatellar area (area 1) had loss of sensation to pinprick, by the end of 30 minutes, but not the rest of the sites. This may be caused by the anatomical variations, with the local anesthetic selectively blocking the infrapatellar branch of the saphenous nerve in the distal transsartorial approach.…”

Section: Discussionmentioning

confidence: 99%

“…The blocks were performed with the patient in the supine position, with the leg slightly externally rotated at the hip. The blocks were performed under ultrasound guidance (Sparq-Philips, Venue 40, GE Healthcare; M-turbo, Sonosite; or Flex Focus 400, BK Medical) with a corresponding linear probe (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) or the curvilinear probe (2-6 MHZ) based on patient characteristics and provider preference. A 21-gauge 90-mm insulated needle (StimuQuick, Arrow) was used for all blocks.…”

Section: Block Performancementioning

confidence: 99%

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A Comparison of 2 Ultrasound-Guided Approaches to the Saphenous Nerve Block

Marian

Ranganath

Bayman

et al. 2015

Regional Anesthesia and Pain Medicine

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“…The saphenous nerve is a cutaneous branch of the femoral nerve, which becomes subcutaneous on the medial side of the knee joint and follows the greater saphenous vein to the medial malleolus (Williams and Sugars, ; Dayan et al, ). Because of its location, the saphenous nerve is less vulnerable than the superficial peroneal and sural nerves during ankle arthroscopy (Ferkel et al, ; Schuberth et al, ).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous innervation of the ankle: An anatomical study showing danger zones for ankle surgery

et al. 2013

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Three nerves innervate the skin in the foot and ankle region: the saphenous, sural, and superficial peroneal nerves. Because they are close to the medial and lateral malleoli, these nerves are at significant risk during orthopedic interventions. The aims of this study were to investigate the distal courses of the three cutaneous nerves of the ankle and to determine their exact relationships with easily identifiable bony landmarks. Ten freshly frozen and 40 embalmed lower extremities of adults were dissected. The positions of the superficial peroneal, sural, and saphenous nerves were determined using reference lines based on easily palpable osseous landmarks. The frequencies and distributions of all three nerves and their branches were converted into absolute numbers. A danger zone for each nerve was established on the basis of the distribution of crossings between the nerves and the different reference lines. Determination of the exact orientation of the nerves around the ankle should help minimize the nerve injury rate during surgical approaches in this area. Using this easily translatable new grid system, the course and danger zones of each cutaneous nerve around the ankle can be estimated clinically.

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Surgical Anatomy of the Saphenous Nerve

Cited by 39 publications

References 3 publications

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

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

A Comparison of 2 Ultrasound-Guided Approaches to the Saphenous Nerve Block

Cutaneous innervation of the ankle: An anatomical study showing danger zones for ankle surgery

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