The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study

Abstract

BackgroundThe skin incision for medial displacement calcaneal osteotomy (MDCO) often damages the sural nerve. We aimed to identify the practical reference area in which the surgeon can incise the skin to minimize the injury of the sural nerve during MDCO.MethodsThe foot and ankles of 20 cadavers were dissected. The landmarks were the following four anatomical references: point A, the tip of the lateral malleolus; point B, the inferior margin of the calcaneus on the vertical line through point A; point C, the posteroinferior apex of the calcaneus; and point D, the lateral border of the Achilles tendon on the horizontal line through point A. The distances from the sural nerve to points A and B in the vertical direction (lines D1 and D2, respectively), to points A and C in the diagonal direction (lines D3 and D4, respectively), and to points A and D in the horizontal direction (lines D5 and D6, respectively) were measured.ResultsThe median ratios of D1 to D1+D2, D3 to D3+D4, and D5 to D5+D6 were 0.34 (range 0.25 to 0.45), 0.23 (range 0.16 to 0.33), and 0.38 (range 0.26 to 0.50), respectively.ConclusionsThe distance ratios according to easily identifiable references would be a more practical incision strategy for surgeons to minimize sural nerve injury in both open and minimally invasive/percutaneous MDCO.

Autopsy‐Based Learning is Essential But Underutilized in Medical Education: A Questionnaire Study

“…Indeed, cadaver specimens have proven useful for practicing basic procedures (Kim et al, 2016). A number of studies have addressed the use of cadavers in experimenting with novel techniques in postgraduate training (Mantica et al, 2020), ones that could help minimize the risk of complications in such procedures (Hampp et al, 2019; Park et al, 2019). Moreover, dissections offer an irreplaceable approach to discovering specific anatomical details such as the nasal bone structure (Roussel et al, 2020).…”

A Novel Technique of Medial Displacement Calcaneal Osteotomy Using the Intramedullary Fixation of a Conventional Low-Profile Locking Wedge Plate

“…Among the critical regions warranting vigilance are the sural nerve, lesser saphenous vein, tibial neurovascular bundle, and the plantar and calcaneal branches of the tibial nerve. 24 This concern becomes even more pronounced, especially within minimally invasive techniques, as underscored by Sherman and Guyton. 28 Minimally invasive approaches entail performing surgery with minimal dissection and direct visualization, heightening the significance of a precise comprehension of the anatomical structures.…”

“…In a comprehensive systematic review, López-López et al 20 have highlighted the need for additional studies to establish a consensus on the most suitable fixation methods and optimal incision lengths for calcaneal osteotomy. Furthermore, numerous studies have been carried out on incision method and osteotomy safe zone to prevent sural nerve injury, 24 32 . and various devices, including headless screws, or step plates, 17 have also been introduced to reduce patients’ discomfort with sufficient stability.…”

Outcomes of Surgical Treatment for Sural Neuritis: A Retrospective Case Series

“…22 Approaches for peroneal tendon pathology, Achilles tendon pathology, lateral ligament instability, calcaneus, talus, fifth metatarsal and fibular fractures, and subtalar and calcaneal cuboid arthrodesis are among those that place the sural nerve at risk for injury. 3,24,27 Iatrogenic sural nerve-related symptoms have been reported to occur in up to a quarter of calcaneal osteotomies, and up to 23% following percutaneous Achilles tendon procedures. 1,[5][6][7]9,20,23,25,32 A paucity of literature exists regarding outcomes of neurectomy with proximal implantation for SN and CSN.…”