Kannan Ruben, Khajuria Ankur, Davies D Ceri, Rymer Ben, Nduka Charles, Koshima Isao
Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK.
Kellogg College, University of Oxford, Oxford, UK.
Microsurgery. 2023 Nov;43(8):818-822. doi: 10.1002/micr.31068. Epub 2023 May 24.
Sural nerve harvest causes paraesthesia to the lateral heel of the foot, which can debilitate those with already compromised proprioception. To circumvent this, we investigated an alternative donor nerve, branch of the lateral sural nerve complex called the sural communicating nerve (SCoNe), for its harvest and use as a vascularized nerve graft, in cadaver.
The SCoNe was visualized by dissection in 15 legs from 8 human cadavers and the relationship of the SCoNe to the overall sural nerve complex was documented. The surface markings, dimensions, and the micro-neurovascular anatomy in the super-microsurgery range (up to 0.30 mm) of the SCoNe was recorded and analyzed.
SCoNe graft surface marking was confined within a triangle drawn between the fibular head laterally, the popliteal vertical midline medially and the tip of the lateral malleolus inferiorly. The proximal end of the SCoNe was situated at a mean intersection distance of 5 cm from both the fibular head and popliteal midline respectively. The mean length of the SCoNe was 226 ± 43 mm with a mean proximal diameter of 0.82 mm and mean distal diameter of 0.93 mm. In 53% of the cadavers, an arterial input was present in the proximal third of the SCoNe and veins were predominantly (87%) present in the distal third. In 46% and 20% of the 15 legs respectively, there was a nutrient artery and vein perfusing the SCoNe in its central segment. The external mean diameter of this artery was 0.60 ± 0.30 mm, while the vein was slightly larger with a mean diameter of 0.90 ± 0.50 mm.
SCoNe graft may preserve lateral heel sensation, compared to sural nerve harvest, pending clinical studies. It may have wide applications as a vascularized nerve graft, including being ideal as a vascularized cross-facial nerve graft because its nerve diameter is similar to the distal facial nerve branches. The accompanying artery is a good anastomotic match to the superior labial artery.
腓肠神经取材会导致足跟外侧感觉异常，这可能会使本体感觉已受损的患者功能减弱。为避免这种情况，我们在尸体上研究了一种替代供体神经，即腓肠外侧神经复合体的分支腓肠交通神经（SCoNe），用于取材并作为带血管神经移植物使用。
通过解剖8具人类尸体的15条腿来观察SCoNe，并记录SCoNe与整个腓肠神经复合体的关系。记录并分析SCoNe在超显微手术范围内（最大0.30毫米）的体表标志、尺寸和微神经血管解剖结构。
SCoNe移植物的体表标志局限于由外侧的腓骨头、内侧的腘窝垂直中线和下方的外踝尖所构成的三角形内。SCoNe的近端分别位于距腓骨头和腘窝中线平均交叉距离5厘米处。SCoNe的平均长度为226±43毫米，近端平均直径为0.82毫米，远端平均直径为0.93毫米。在53%的尸体中，SCoNe近端三分之一处有动脉供血，静脉主要（87%）位于远端三分之一处。在15条腿中，分别有46%和20%在SCoNe的中央段有滋养动脉和静脉灌注。该动脉的外部平均直径为0.60±0.30毫米，而静脉稍大，平均直径为0.90±0.50毫米。
与腓肠神经取材相比，SCoNe移植物可能保留足跟外侧感觉，有待临床研究验证。它作为带血管神经移植物可能有广泛应用，包括作为带血管跨面神经移植物很理想，因为其神经直径与面神经远端分支相似。伴行动脉与上唇动脉是良好的吻合匹配。
