Endoscopically assisted sural nerve harvest in infants.

A technique of endoscopic sural nerve harvest was devised to minimize the donor site scarring in infants requiring peripheral nerve grafting procedures. The harvests were performed under tourniquet control using three 2-cm incisions for access at the lateral malleolus, midcalf, and popliteal fossa. Endoscopic visualization and blunt dissection of the nerve was achieved with a 4-mm-diameter, 18-cm-long telescope with a 0-degree angle lens, stabilized in an Emory retractor and attached to a video camera. The medial sural nerve was divided in the popliteal fossa proximally under direct vision. The lateral sural nerve was identified and harvested when present. This technique has been in use since 1994 and has been undertaken in more than 200 patients. The most common indication for surgery was obstetrical brachial plexus palsy. No nerve graft injury was noted upon examination under the operating microscope. Postoperative pain, swelling, and ecchymosis were minimal. Most patients have a detectable area of sensory loss at long-term follow-up but are unaware of this finding. Donor site scarring has been aesthetically satisfactory.