Nerve grafting peripheral nerve disorders if the ends of a cut or damaged nerve do not reach, then a nerve graft needs to be placed in between. It lies in close proximity to the small saphenous vein and passes distally near the lateral margin of the calcaneus tendon. Sural nerve interposition grafting during radical prostatectomy. Apel presents a case of a patient with an ulnar nerve injury, treated with autologous sural nerve grafting and aintodeep ulnar motor nerve. Crossfacial nerve graft is considered the treatment of choice for facial reanimation in patients with. Sural or other nerve grafts to restore erectile function during radical prostatectomy are unproven and not medically necessary due to insufficient evidence of efficacy.
It divides into medial and lateral branches in 18%100% in frequency, respectively. Larger superficial defects can be reconstructed by fasciocutaneous free flaps, whereas deep defects, especially in combination with osseous, defects should be reconstructed by muscle flaps. Tm sural nerve extractor for a minimally invasive harvesting of the sural nerve. Mar 27, 2019 the sural nerve is widely used as an autologous nerve graft for peripheral nerve surgery because it has some considerable advantages such as easy and quick harvest, adequate length, straight course with minimal branching, appropriate calibration, high number of fascicular groups, and low donor site morbidity 3, 4. Meyers is snis 2010 annual meeting chairman announcing dr. The tiny venous radicles draining nerves are free of valves.
Patients who received a nerve graft taken from the thigh a genitofemoral nerve graft instead of the ankle were as likely to recover erectile function as those who received a sural nerve graft. After the sural nerve is cleared from the surrounding tissue, the nerve is cut, removed from the body, and prepared for grafting. Pdf alternatives to sural nerve grafts in the upper. The sural fasciocutaneous flap relies on the vascular axis of the sural nerve which consists of the median superficial sural. The cross face graft guides the regenerating nerve fibers as they migrate across the face to repopulate the injured muscles of facial expression. Ultrasonography us is widely considered to be an effective, accurate, dynamic, and noninvasive technique for assessment of peripheral nerves of the extremities. The sural nerve is a sensory nerve in the calf region of the leg. Of these seven patients in the concomitant group, four patients had neurolysis, one patient had a neuroplasty, and two patients had sural nerve grafting. There are a lot of anatomical variations in the anatomy of the sural nerve. All robotic surgery procedures were successfully accomplished median operating time. Peripheral nerve reconstruction with autologous grafts. In peripheral nerve surgery, the sural nerve graft is the most often used donor nerve with its advantages like easy dissection, adequate length, and.
Surgical techniques ulnar nerve grafting with ainto. Compared to other vascularized nerve grafts, the sural nerve has many advantages. When the length of nerve graft need is limit ed, the peroneal communicating branch can be harvested alone and the medial sural cutaneous nerve can be saved. In the top panel, the nonconducting neuroma has been excised, and the sural nerve graft is sized about 10% longer than the gap so that a tension free anastomosis bottom panel can be performed. Some common nonoperative treatment options include. Your doctor will ask about your symptoms and take a closer look at your foot. In most cases, a traditional parotidectomy skin incision is used to locate the buccal and zygomatic branches of the facial nerve. The sural nerve is the most commonly used nerve for grafting severe nerve defects. Subjective outcome related to donor site morbidity after.
Microsurgical robotic suturing of sural nerve graft for. The sural nerve is often harvested and used when nerve grafts are required to repair other nerves in the body. The sural nerve, the most common donor nerve, is considered expendable and has been used extensively in other nerve grafting procedures, such as brachial plexus and peripheral nerve injuries. The free vascularized sural nerve graft wiley online library. This novel method reinnervates the cornea, avoids the cosmetically objectionable bicoronal scar, and is more versatile than the previous bicoronal approach. Techniques for nerve grafting request pdf researchgate. The nerve is comprised of spinal nerve roots from s1 and s2. The reverse sural fasciocutaneous flap offers the surgeon a straightforward procedure that minimizes donorsite morbidity and preserves the major arteries and nerves of the leg. As said before, the sural nerve is a peripheral nerve. Restoration of corneal sensation with regional nerve. A blunttip instrument with recessed cutting jaws at the distal end. Furthermore, the sacrifice of the sural nerve results in hyposensitivity of the lateral border of the foot.
We report 3 cases of large defect sciatic nerve reconstruction using the bilateral sural nerves of the lower legs harvested together with the fascia and lesser saphenous vein to form. A reliable technique of free vascularized sural nerve grafting and. To our knowledge, this is the first report of restoration of corneal sensation using a sural nerve graft in unilateral and bilateral anesthetic corneas. Pdf zancolli procedure and nerve repair with sural graft. Figure 2 a the sural nerve was harvested from a small incision performed in the left lateral malleolus, behind the small saphenous vein. Nerve grafts can restore sensation and movement to areas. The sural nerve is a sensory nerve of the lower lateral leg and lateral aspect of the foot. In addition, preoperative and postoperative manual muscle testing.
In most cases, sural nerve problems can be managed with nonsurgical treatment techniques. Nerve graft with radical prostatectomy bridgespan health. It is vulnerable at the posterior border of fff skin elevation. Code correct for neurectomy of the sural nerve supercoder. The nerve is identified near the ankle level and traced up to the knee level. Robotic laparoscopic sural nerve graft is a procedure used to help restore erectile function to patients when nerve sparing prostatectomy isnt an option. We report 3 cases of large defect sciatic nerve reconstruction using the bilateral sural nerves of the lower legs harvested together with the fascia and lesser saphenous vein to. This nerve also provides sensation to the outside of the foot and the two outside toes. Fortysix patients were asked to fill in a questionnaire to describe symptoms from leg or foot, where the sural nerve has been harvested to reconstruct an injured major nerve trunk. Once formed, the nerves runs down the mid calf to the ankle and along the skin from the midposterior popliteal fossa to just behind to. Jan 10, 2008 operative time was statistically longer for both sural graft cohorts when compared with unilateral without graft and bilateral nerve sparing cohorts. In cases where there are five or more fascicles in the damaged nerve, these fascicles may be grafted and sutured individually. Fortytwo per cent of patients complained of tenderness in the calf, likely to be due to neuroma formation. Contralateralnormal facial nerve via crossfacial nerve graft.
In the posterior calf, the sural nerve emerges from between the two heads of the gastrocnemius muscle and runs with the small saphenous vein inferiorly to curve under the lateral malleolus. We prefer harvesting the sural nerve graft because the access is not. The sural nerve is formed from branches of the fibular and tibial nerves. Our aim was to evaluate subjective outcome in the lower leg after harvesting the sural nerve for grafting nerve defects. The sural nerve is a sensory nerve of the lower limb formed by the union of sural branch of the tibial nerve and the communicating sural branch of the common fibular nerve supplying sensation to the lower lateral aspect of the calf and foot gross anatomy. The sural artery flap is insensate and is not an option in cases in which sensitivity is an issue. Nerve graft to restore erectile function during radical. With a relatively easy technique, up to 25 cm of nerve graft may be harvested. The sural nerve has a purely sensory function, and so its removal results in only a relatively minor deficit. The sural nerve was described as a new donor nerve of the free vascularized nerve graft in a fresh cadavers dissection and in four clinical cases.
Also known as nerve cells, the neurons are divided into 3 main categories. Applicable codes the following lists of procedure andor diagnosis codes is provided for reference purposes only and may not be all inclusive. A nerve graft is a surgical technique in which a segment of unrelated nerve is used to replace or bridge an injured portion of nerve. The sural nerve innervates the back of the calf and the outside of the ankle. Background vascularized nerve grafting is normally associated with a good outcome, but can be difficult to use for nerve reconstruction in patients with long defects of the sciatic nerve given the graft thickness. Our general interest enewsletter keeps you up to date on a wide variety of health topics. Harvesting of free grafts for head and neck surgery springerlink. Historically, the sural nerve has been harvested using. What are the downsides of harvesting the sural nerve.
The sural nerve grafts are frequently used as cable grafts. Dissociation of sexual function and sexual bother following. Jul 30, 2014 ulnar nerve injury with drill bit perpetration presenting 2 weeks later with ulnar claw. This is often the case with stretch injuries or when there is extensive scar in the nerve that has to be removed.
Sural nerve definition of sural nerve by medical dictionary. Pdf sural nerve interposition grafting during radical. A b figure 3 robotic sympathetic nerve reconstruction 5. To repair a damaged nerve, your surgeon removes a small part of the sural nerve in your leg and implants this nerve at the site of the repair. In peripheral nerve surgery, the sural nerve graft is the most often used donor nerve with its advantages like easy dissection, adequate length, and calibration 3, 4.
Sural nerve damage is, in fact, a subclass of peripheral neuropathy. The effects of sural nerve excision in autogenous nerve. The donor nerve serves as a track along which axons appendages of neurons. Reconstruction was performed with the sural nerve in all cases median nerve graft length. This study was conducted to evaluate the functional outcomes of patients who underwent facial nerve cable grafting immediately after tumor resection. In practice, an endtoend repair does not result in a better functional result than a welldone nerve graft 3. The nerve gap was over 6 cm and too long for nerve graft reconstruction, so he underwent tmr with sural neuroma excision and transfer to motor nerve of lateral gastrocnemius muscle fig. A sensory nerve from the lower leg sural nerve is removed and attached to a facial nerve branch on the normal side. We prefer harvesting the sural nerve graft because the access is not limited when using a twoteam approach, and morbidity at the donor site is negligible.
This usually requires two surgeries, unless in certain circumstances where two nerve options are used. Manual of head and neck reconstruction using regional and free. Sural nerve grafting in robotic laparoscopic radical. Nerve grafts are often available at the site of free tissue harvestlateral cutaneous nerve of the thigh and femoral nerve branches anterolateral thigh, sural nerve medial sural artery flap, lateral cutaneous nerve of the forearm radial forearm flap, and thoracodorsal nerve latissimus dorsi flap. Andersons spasticity program has grown by leaps and bounds aneurysm aneurysm clipping aneurism anuerysm angevine brings spinal deformity expertise to aans 20 ankylosing spondylitis ann riley finck wins columbias clinical nursing excellence award announcement. Download fulltext pdf zancolli procedure and nerve repair with sural graft as a treatment for patient with claw hand due to complete rupture of ulnar and median nerve. Helps reduce trauma, complications and significantly shortens removal of graft. Pdf functional outcomes of multiple sural nerve grafts for. Nerve repair and grafting in the upper extremity medscape. Small superficial defects of the lower onethird of the leg can be treated by a sural artery flap if the defect size is smaller than 6. The coapted nerve is wrapped in a dura regeneration. Preoperatively, rule out previous trauma or surgery at the donor site. For this reason, it is often used for nerve biopsy, as well as the donor nerve when a nerve graft is performed.
The vascularized sural nerve is nourished by the cutaneous branch of the peroneal artery or the muscular perforating branch of the posterior tibial artery in our grafts. Pdf alternatives to sural nerve grafts in the upper extremity. No significant differences in subjective or objective sexual function, sexual bother, or urinary function were seen with 6 and 12 months followup, possibly related to smaller sural cohorts. Vascularized nerve grafts and vascularized fascia for upper. A dispensable sensory nerve sural nerve is usually harvested from the leg and utilized as a long interposition graft to connect the facial nerves on both sides of the face. Management of sural nerve neuromas with targeted muscle. If you dont see any interesting for you, use our search form on bottom v. What causes sural nerve compression and how to manage it. Parotidectomy fat graft neoplasm surgery reconstruction fascia lata facial palsy dural repair csf leak sural nerve. Nerve grafting peripheral nerve disorders department of. B harvesting and preparation of a 30cm sural nerve graft. It is made up of branches of the tibial nerve and common fibular nerve, the medial cutaneous branch from the tibial nerve, and the lateral cutaneous branch from the common fibular nerve.
Several men who had a genitofemoral nerve graft experienced chronic numbness in the thigh and scrotum following surgery. Vascularised nerve grafts using composite arterialised neuro. Plastic surgeons commonly encounter sural nerve during flap harvest as well as during nerve grafting. Table 1 techniques for treatment of peroneal nerve palsy. Reports also indicate the use of other nerves eg, genitofemoral nerve for grafting. Regulatory status a nerve graft with radical prostatectomy is a surgical procedure and, as such, is not subject to regulation. It travels within subcutaneous tissue adjacent to the small saphenous vein in the lower posterolateral calf. Treatment of peroneal nerve injuries with simultaneous tendon. Sural nerve graft harvest iowa head and neck protocols. Treating sural nerve issues begins with an accurate diagnosis, and this is best achieved through a physical exam with an orthopedic specialist.
The sural nerve is a purely sensory nerve that supplies sensation to the dorsal lateral foot, lower ankle, heel, and lower posteriorlateral leg. The effect of excising fifty sural nerves from the legs of fortyfive patients undergoing nerve grafting are described. The sural nerve is a sensory nerve providing innervation to the lateral surface of the foot and ankle. At 6 month followup, the patient reported no pain and normal ambulation, even with manipulation of the nerve coaptation site. Methodology open access peroral crossfacial sural nerve graft for facial reanimation joohee jeong2, akram abdo almansoori1, hyunsoo park1, soohwan byun5, seungki min2, hanwool choung1, joo yong park2, sung weon choi2, bongju kim6, soungmin kim1,4 and jongho lee1,3,4 abstract background. Peroral crossfacial sural nerve graft for facial reanimation. Photosbeforeleftand1yearafterrightofapatientwhounderwent crossfacial nerve grafting with the sural nerve followed by gracilis. Use of vascularized sural nerve grafts for sciatic nerve. Morbidity associated with the sural nerve harvest is low and stems from the approach used. The goal of sural nerve treatment is to free the nerve from the underlying issue that is causing the irritation. The body the body page 7 of 7 part value is g, tibial nerve because the sural nerve is a branch of the tibial nerve. Pdf zancolli procedure and nerve repair with sural graft as. The technique for nerve grafting during the rrp and harvesting the sural nerve has been described previously. Sural nerve cable graft to ulnar nerve hand surgery international.
The average length of the sural nerve graft was 78 cm for unilateral grafting and. In the top panel, the nonconducting neuroma has been excised, and the sural nerve graft is sized about 10% longer than the gap so that a tensionfree. Therefore, it is used to communicate with the brain and the spinal cord. Allows for harvest of sural nerve grafts up to 73cm in length.
Corneal graft with amniotic membrane transplantation, limbal stem cell transplantation, or sural nerve grafting. Harvest of the sural nerve is us ually performed with the patien t in a supine position, with the lower extremity flexed and in ternally rotated at the hip, flexed about 40 degrees at the. Intraoperative photographs demonstrating split fascicular sural nerve graft repair of an accessory nerve that had been damaged 7 months previously. Pulsed radiofrequency of the sural nerve for the treatment.
Request pdf techniques for nerve grafting the nerve graft can be. This cpb has been revised to state that sural nerve grafting is considered experimental and investigational for the treatment of neurotrophic keratitis. Jan 17, 2018 the sutures attach the graft to either side of the damaged nerve, or, for the graft to nowhere, one end is attached to a damaged nerve and the other embedded in the muscle. The sural nerve is the most common nerve graft donor despite requiring a second operative limb and causing numbness of the lateral foot. Both free ends of the cavernous nerve were trimmed, and the harvested sural nerve segment was anastomosed using 70 prolene under 4. A biopsy of the donor facial nerve is obtained for axonal count, and 23 epineurial 90 nylon sutures are used to complete the neurorrhaphy. What is the difference between a nerve graft and a nerve transfer.
The sural fasciocutaneous flap relies on the vascular axis of the sural nerve which consists of the median superficial sural artery and the lesser saphenous vein. Crossfacial nerve graft is considered the treatment. In this study, crossfacial nerve graft with the sural nerve was planned for three patients with. The sural nerve is a unique sensory nerve in that it often though not always forms distally from a combination of 2 peripheral sensory nervesthe medial and lateral sural nerves. However, such a diversion may be as timeconsuming as harvesting and placing a graft, and mobilisation of the nerve from the fallopian canal can cause nerve ischaemia and hence disappointing results. Crossfacial nerve graft is considered the treatment of choice for facial reanimation in patients with unilateral facial palsy caused by central facial nerve damage. Nerve grafts are used when a patient has a nerve injury resulting in complete loss of muscle function or sensation.
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