Department of Traumatology and Orthopedics, Clinical Hand Surgery Fellow, Governador Celso Ramos Hospital, Florianopolis, Santa Catarina, Brazil; Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Department of Traumatology and Orthopedics, Clinical Hand Surgery Fellow, Governador Celso Ramos Hospital, Florianopolis, Santa Catarina, Brazil; Department of Surgical Techniques, Federal University of Santa Catarina, Brazil.
J Hand Surg Am. 2023 Nov;48(11):1173.e1-1173.e7. doi: 10.1016/j.jhsa.2023.03.009. Epub 2023 Apr 13.
The sural nerve is the autologous nerve used most commonly for grafting. However, recent studies indicate a high rate of complications and complaints after sural nerve removal. In this prospective study, we evaluated donor-site morbidity following full-length sural nerve harvesting on long-term follow-up.
Fifty-one legs from 43 patients who underwent complete sural nerve harvesting for brachial plexus reconstruction were included in the study. After an average of 5 years, with a minimum postoperative follow-up of 12 months, sensory deficits in the leg and foot were analyzed using 2.0-g monofilaments. Regions of sensory deficit were marked with a skin marker and photographed. Over these regions of decreased sensation, we tested nociception using an eyebrow tweezer. Patients were also asked about pain, cold intolerance, pruritis, difficulties walking, and foot swelling.
Regions most affected (84% of patients) were over the calcaneus and cuboid. However, in these regions, nociception was preserved. Regions of decreased sensation extended to the calf region in 11 of 51 legs. In 13 patients, we also observed regions of decreased sensation on the proximal leg. In five feet, the sensation was entirely preserved. No patient had any complaints about pain, cold intolerance, itchiness, difficulties walking, or foot swelling.
Decreased sensation with nociception preserved was most common along the lateral side of the foot over the calcaneus and cuboid. Removing the entire sural nerve produced no long-term complaints of pain. Sural nerve use appears safe.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
腓肠神经是最常被用于移植的自体神经。然而，最近的研究表明，腓肠神经切除后并发症和投诉的发生率很高。在这项前瞻性研究中，我们在长期随访中评估了全长腓肠神经采集后的供区发病率。
纳入 43 例患者的 51 条腿，这些患者因臂丛神经重建而行完整腓肠神经采集。平均随访 5 年后（术后至少随访 12 个月），使用 2.0-g 单丝分析腿部和足部的感觉缺失。用皮肤标记物标记感觉缺失区域并拍照。在这些感觉减退区域，我们使用眉毛夹测试痛觉。还询问了患者的疼痛、怕冷、瘙痒、行走困难和足部肿胀情况。
受影响最严重的区域（84%的患者）是跟骨和骰骨。然而，在这些区域，痛觉仍然存在。51 条腿中有 11 条腿的小腿区域感觉减退。13 例患者还观察到小腿近端感觉减退区域。在 5 只脚中，感觉完全保留。没有患者出现疼痛、怕冷、瘙痒、行走困难或足部肿胀的任何抱怨。
感觉减退伴痛觉保留最常见于跟骨和骰骨外侧的足部。切除整个腓肠神经不会引起长期疼痛的投诉。腓肠神经的使用似乎是安全的。
研究类型/证据水平：治疗性 II 级。
