The surgical anatomy of the sural nerve: An ultrasound study

Abstract

The aim of this study was (a) to examine the anatomy of the sural nerve (SN) in a sample of 30 patients and (b) to analyze the incidence of different origins of the SN, and the distance of the SN from planned arthroscopic portals. An ultrasound (USG) examination of the SN was performed bilaterally on thirty healthy patients with no history of surgery or trauma of the lower limb. The SNs were classified into six main types of pattern, with an additional category for new and unclassified types. Each of Types 1 and 3 had two subdivisions. The distances from the superior border of the calcaneal tuberosity to the three simulated arthroscopy portal sites (Z1, Z1.5, Z2) to the SN were measured. A total of 30 patients (n = 60 limbs) with an average age of 27 ± 7.5 years were examined and the SN was visualized in all cases. The most common origin was Type 3A, accounting for 30% of limbs. Type 2 was the second most common seen in 18.3%. The distances of the SN from arthroscopic portal placement sites above the lateral malleolus were 2.07 ± 0.39 cm at the Z1 portal, 2.15 ± 0.38 cm at Z1.5, and 2.28 ± 0.33 cm at Z2. The variability in the anatomy of the SN warrants the use of USG to locate it accurately, thus preventing iatrogenic injury when portals are placed for arthroscopy, improving proper administration of anesthesia, and helping to localize the nerve for graft harvesting. Clin. Anat. 31:450-455, 2018. © 2017 Wiley Periodicals, Inc.

Risk of injury to the sural nerve during posterolateral approach to the distal tibia: An ultrasound simulation study

“…Ultrasound (USG) was used to locate the SN and to assess risk of injury at each respective potential surgical incision site. USG has previously been proven to be a reliable tool to identify the course of the SN, may be more reliable than cadaveric studies, and decreases the risk of shifting anatomical structures (Popieluszko, ). By revealing how length and position of the surgical incision influence risk of SN injury, we hope to provide information to surgeons on the optimal technique to avoid iatrogenic SN injury while operating on the distal tibia via a posterolateral approach.…”

The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants

“…Rodriguez‐Acevedo et al () reported the classical arrangement in only 55.7% with variations including: close proximity of the SN to the SSV above the mid‐calf point, a proximal and a distal SN lateral communicating branches, the SN becoming subcutaneous and piercing the fascia at a high point, and the SN being medial to the SSV (Rodriguez‐Acevedo et al, ). Furthermore, asymmetry was reported as high as 43.3% (Popieluszko et al, ). Other research has demonstrated the strict medial path of the SSV in relation to the SN (Eid and Hegazy, ).…”

“…Other research has demonstrated the strict medial path of the SSV in relation to the SN (Eid and Hegazy, ). Recent publications have shown that preoperative ultrasound assessment is an effective tool in identifying and locating even small nerves, reducing the risk of their injury (Pękala et al, ; Popieluszko et al, ). Similarly, the results obtained from this study support the use of ultrasound as a relatively safe and quick method to visualize potential variations in the course and relationship between the SN and SSV prior to any surgical intervention in the leg.…”

“…The SN can run superficial or medial to the SSV (Schweighofer et al, ; Ramakrishnan et al, ). Furthermore, published literature discussed the variations of the SN with regard to its origin pattern, course and branching pattern, and morphometrics and symmetry within an individual (Ramakrishnan et al, ; Jeon et al, ; Popieluszko et al, ).…”

“…In a cadaveric study, the SN and the SSV crossed the incision site in 83.3% of cases, putting them at risk of iatrogenic injury during a posterolateral approach for the treatment of posterior malleolar fractures (Jowett et al, ). Previous studies have discussed the close proximity and variation between the two structures (Kerver et al, ; Ramakrishnan et al, ; Popieluszko et al, ). Consequently, there is an increased risk of nerve injury during local diagnostic and therapeutic procedures (Kerver et al, ).…”