Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic; Spinal Surgery Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Ann Anat. 2024 Jun;254:152242. doi: 10.1016/j.aanat.2024.152242. Epub 2024 Mar 6.
The sural nerve is a somatosensory nerve that provides sensation to the posterolateral aspect of the lower leg and the lateral part of the ankle and foot. Due to its location and anatomical properties, it is often used as an autologous nerve graft. However, the nerve harvest can be complicated by the presence of side branches. The objective of this study was to investigate the anatomy of the sural nerve and to map its side branches. This information can be used to predict the localization of separate incisions during the stair-step incisions technique for nerve harvest, thereby reducing the risk of complications.
The study involved the dissection of 50 adult cadaveric legs (25 left and 25 right) obtained from 27 Central European cadavers. The focus of the dissection was to identify the sural nerve, small saphenous vein, and surrounding anatomical structures. Detailed measurements were taken on the side branches of the sural nerve, tributaries of the small saphenous vein, and their interrelationship.
The average number of sural nerve side branches in a single leg was 4.2±1.9. These side branches were categorized into six groups based on their location and course: mediodistal, medioproximal, lateroproximal, laterodistal, medial perpendicular, and lateral perpendicular. Specific patterns of combination of these side branches were also identified and described. The branching point of the sural nerve was found to be 5.8±2.7 cm proximal to the lateral malleolus, whereas the small saphenous vein branching point was located more distally, 4.5 ± 2.8 cm proximal to the lateral malleolus. The highest density of sural nerve side branches was found 2.1-6.0 cm above the lateral malleolus.
This study presents valuable data about the relationship between the sural nerve and the surrounding anatomical structures in the distal part of the leg, including the identification of its side branches and their relevance during nerve harvest procedures. On the basis of the most frequent locations of side branches, a three-incision-technique for nerve harvest is proposed.
腓肠神经是一种躯体感觉神经，为小腿后外侧和足外侧部分提供感觉。由于其位置和解剖学特性，常被用作自体神经移植物。然而，神经采集可能会因存在侧支而变得复杂。本研究的目的是探讨腓肠神经的解剖结构，并绘制其侧支的分布图。这些信息可用于预测在神经采集的阶梯切口技术中单独切口的定位，从而降低并发症的风险。
本研究涉及对 27 名中欧尸体的 50 条成人尸体腿（25 条左腿和 25 条右腿）进行解剖。解剖的重点是识别腓肠神经、小隐静脉和周围的解剖结构。对腓肠神经侧支、小隐静脉属支及其相互关系进行了详细测量。
单腿腓肠神经侧支的平均数量为 4.2±1.9 条。根据位置和走行，这些侧支分为 6 组：远中-近侧、中-近侧、远中-近侧、远中-远侧、内侧垂直和外侧垂直。还确定并描述了这些侧支的特定组合模式。腓肠神经的分支点位于外踝近端 5.8±2.7cm，小隐静脉的分支点位于外踝近端 4.5 ± 2.8cm。腓肠神经侧支密度最高的部位位于外踝上方 2.1-6.0cm。
本研究提供了关于腓肠神经与小腿远端周围解剖结构关系的有价值的数据，包括其侧支的识别及其在神经采集过程中的相关性。基于侧支最常见的位置，提出了一种三切口神经采集技术。
