Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.

Greater auricular nerve neuropraxia with beach chair positioning during open reduction and internal fixation with plate for clavicular fracture: A case report

Greater auricular nerve neuropathy is a reported as complication in some cases of shoulder arthroscopy in the beach chair position using a horse-shoe headrest. Due to this risk, intubation pad-type headrest is recommended for the beach chair position, to effectively prevent greater auricular nerve palsy. In this case report, we described a patient who experienced greater auricular nerve neuropraxia after open reduction and internal fixation with plate of clavicular fracture in beach chair position using an intubation pad-type headrest. A 49-year-old man was diagnosed with left clavicular fracture without accompanying injury or complication. He underwent an operation for open reduction and internal fixation with a plate. After surgery, the patient reported numbness, and a tingling sensation without pain or skin lesion in the auricular area and the lower margin of the left mandible. Based on the clinical symptoms, greater auricular nerve neuropraxia was diagnosed. The symptoms disappeared completely after four weeks of outpatient follow-up.

New Method and Usefulness of Study on Sensory Nerve Conduction of Lateral Sural Cutaneous Nerve

OBJECTIVE: To find a new method and usefulness of study on sensory nerve conduction of lateral sural cutaneous nerve (LSCN). METHOD: The 60 extremities of 30 adults without peripheral neuropathy were placed in a prone position. Next, each subject was administered with an antidromic stimulation at a point 3 cm lateral from the center of the popliteal fossa. With the aid of active electrodes, the sensory nerve action potentials (SNAPs) were recorded at points 10 cm inferior and 1 cm lateral to the stimulation site. The method of sensory nerve conduction study suggested by Campagnolo et al. was performed simultaneously, to compare of the frequency of SNAPs and the amplitudes. RESULTS: For the sensory nerve conduction study of the LSCN suggested in this report, SNAPs were obtained in 49 extremities, with a revelation rate of 81.7%. The mean amplitude was 11.91+/-3.68micronV. In the results of the tests suggested by Campagnolo et al., the SNAPs were obtained in 29 extremities, with a revelation rate of 48.3%. The mean amplitude was 8.37+/-5.21micronV. Significance testing of the electrodiagnostic method recommended in this study revealed that many SNAPs were observed for the LSCN, with statistically significant action potential amplitudes. CONCLUSION: This study presents the new method and reference values of sensory nerve conduction for LSCN, which is thought to be useful in electrodiagnostic studies to diagnose entrapment neuropathy.