Hassanpour Esmail, Yavari Masoud, Karbalaeikhani Ali, Saremi Hossein
Hand and Microsurgery Department, 15 Khordad Hospital, Tehran, Islamic Republic of Iran.
Hand and Microsurgery Department, Emam Reza Hospital, Tehran, Islamic Republic of Iran.
J Neurol Surg A Cent Eur Neurosurg. 2014 Mar;75(2):161-4. doi: 10.1055/s-0032-1330117. Epub 2013 Feb 8.
Sural nerve has the favorite length and size for nerve graft interposition. Here two techniques, that is, "stocking seam" and "stair-step" or "stepladder," have been used for harvesting sural nerve. The first technique results in an unsightly scar at the posterior calf, and the latter one takes a long time to perform and exert undue traction to the graft during harvesting. The purpose of this article is to describe our experience in harvesting the sural nerve by a nerve stripper.
A nerve stripper was used for harvesting sural nerve in 35 adult patients (in 6 patients, sural harvesting was done bilaterally), 27 men and 8 women. Thirty-one sural nerve harvests were done by closed technique (i.e., harvesting of sural nerve only by two incisions, one in the posterior of the lateral malleolus and the other in popliteal fossa), in 8 others by limited open technique, and in 2 cases, there was early laceration of the sural nerve at the beginning of the study. The contralateral sural nerve was harvested in one patient and medial antebrachial nerve in another by open technique.
The mean length of the retrieved sural nerve was 34.5 cm in the closed technique group and 35 cm in the limited open technique group. We detected advancing Tinel's sign in all nerve stripper-assisted sural nerve harvested group members in both the closed and limited open groups.
Sural nerve harvesting by the nerve stripper is a reliable and simple technique, and it is applicable as a routine technique. Applying controlled rotatory movements of the nerve stripper instead of pushing can result in satisfactory harvesting of the sural nerve without early laceration.
腓肠神经具有适合用于神经移植的长度和大小。目前有两种获取腓肠神经的技术，即“袜状缝合法”和“阶梯式”或“梯形法”。第一种技术会在小腿后侧留下难看的疤痕，而后者操作耗时较长，且在获取过程中会对移植神经施加过度牵拉。本文旨在描述我们使用神经剥离器获取腓肠神经的经验。
使用神经剥离器为35例成年患者（其中6例双侧获取腓肠神经）获取腓肠神经，男性27例，女性8例。31例采用闭合技术（即仅通过两个切口获取腓肠神经，一个在外侧踝后方，另一个在腘窝）获取腓肠神经，8例采用有限开放技术，2例在研究开始时腓肠神经早期出现撕裂伤。1例患者通过开放技术获取对侧腓肠神经，另1例获取前臂内侧神经。
闭合技术组获取的腓肠神经平均长度为34.5 cm，有限开放技术组为35 cm。在闭合组和有限开放组中，我们在所有使用神经剥离器辅助获取腓肠神经的组内成员中均检测到了Tinel征进展。
使用神经剥离器获取腓肠神经是一种可靠且简单的技术，可作为常规技术应用。采用神经剥离器的可控旋转运动而非推压操作，能够在不造成早期撕裂伤的情况下令人满意地获取腓肠神经。
