The effect of ultrasound-guided continuous saphenous nerve block on preemptive analgesia in elderly patients undergoing unilateral total knee arthroplasty under general anesthesia / 中国医师进修杂志

Objective:To investigate the effect of ultrasound-guided continuous saphenous nerve block on preemptive analgesia in elderly patients undergoing unilateral total knee arthroplasty(TKA) under general anesthesia.Methods:A total of 120 elderly patients who received unilateral TKA in the Affiliated Hospital of Jining Medical College from June 2020 to October 2020 were enrolled and they were divided into group A (saphenous nerve block + general anesthesia), group B (femoral nerve block + general anesthesia) and group C (simple general anesthesia) by random numbering method, with 40 cases in each group. The visual analogue pain (VAS) scores, knee range of motion, RS agitation scores and Ramsay sedation scores at different time points after surgery and postoperative recovery and analgesia were compared among the three groups.Results:The static state and dynamic state VAS scores in the group A and group B at 6, 12, 24, 48 h after the surgery had no significant differences ( P>0.05). The knee range of motion in the group A at 6, 12, 24, 48 h after the surgery were higher than that in group B and group C: (74.8 ± 8.1)° vs. (68.4 ± 8.2)°and (63.2 ± 7.0)°, (77.4 ± 10.9)°vs.(73.0 ± 10.0)° and (68.6 ± 8.3)°, (82.6 ± 10.4)° vs. (77.4 ± 9.6)°and (73.2 ± 8.3)°, (91.8 ± 6.1)° vs. (86.8 ± 6.6)° and (82.8 ± 5.3)°, the differences were statistically significant ( P<0.05). The RS agitation scores and Ramsay sedation scores in the group A and group B had no significant differences ( P>0.05). The first time to the ground in the group A was shorter than that in the group B : (20.9 ± 3.0) h vs. (27.4 ± 3.5) h; the walking distance in the group A was longer than that in the group B: (7.1 ± 1.6) m vs. (5.2 ± 1.3) m, the differences were statistically significant ( P<0.05). Conclusions:Ultrasound-guided continuous saphenous nerve block has a good postoperative analgesic effect in elderly patients with unilateral TAK under general anesthesia. It can promote the recovery of directional force and knee range of motion in patient.

A Comparison between Oblique and Vertical Incisions on the Hamstring Tendon Harvesting in Anterior Cruciate Ligament Reconstruction and Infrapatellar Branch Injury of the Saphenous Nerve / Uma comparação entre incisões oblíquas e verticais na coleta do tendão dos isquiotibiais na reconstrução do LCA e na lesão do ramo infrapatelar do nervo safeno

Abstract Objective The present study aimed to compare the oblique and vertical incisions in hamstring tendon harvesting in anterior cruciate ligament (ACL) reconstruction and in infrapatellar branch injury of the saphenous nerve. Methods The present study was conducted at a tertiary referral center for 12 months. Patients with an indication of reconstruction of ACL tear were included in the study, who were then randomized into two groups (vertical [VG] and oblique [OG] groups). After excluding a few cases, 92 patients were eligible for further analysis (VG: n= 44; OG: n = 48). They were followed-up for 9 months after the surgery, and loss of sensation over the knee and over the proximal aspect of the operated leg was recorded. Results The mean lengths of the incisions were 27 mm and 38 mm for the OG and VG groups, respectively. The total rate of hypoesthesia was 40% (27 patients). A total of 12 (25%) and 25 patients (56.8%) on the OG and VG groups, respectively, reported hypoesthesia symptoms. The presence of hypoesthesia in patients in the VG group was two times higher than in the OG group. No statistical correlation was observed between the nerve injury and age, gender, education, and delay from injury to reconstruction. Conclusion Oblique incision, which showed lower risk of nerve damage, might be more recommended for graft harvesting. Patients who underwent reconstruction of the ACL in the OG group had a lower incidence of peri-incisional hypoesthesia when compared to those in the VG group.

Resumo Objetivo O presente estudo teve como objetivo comparar as incisões oblíquas e verticais na coleta dos tendões dos isquiotibiais na reconstrução do ligamento cruzado anterior (LCA) e na lesão do ramo infrapatelar do nervo safeno. Métodos O presente estudo foi realizado em um centro de referência terciário por 12 meses. Pacientes com indicação de reconstrução de uma ruptura do LCA foram incluídos no estudo, os quais foram randomizados em dois grupos (vertical [GV] e oblíquo [GO]). Após a exclusão de alguns casos, 92 pacientes foram elegíveis para análise posterior (GV: n= 44; GO: n = 48). Eles foram acompanhados por 9 meses após a cirurgia, e a perda de sensibilidade sobre o joelho e sobre o aspecto proximal da perna operada foi registrado. Resultados Os comprimentos médios da incisão foram de 27 mm e 38 mm para os grupos GO e GV, respectivamente. A taxa total de hipoestesia foi de 40% (27 pacientes). Um total de 12 (25%) e de 25 pacientes (56,8%) dos grupos GO e GV, respectivamente, relataram sintomas de hipoestesia. A presença de hipoestesia em pacientes no grupo GV foi duas vezes maior do que no grupo GO. Não foi observada correlação estatística entre a lesão do nervo e idade, gênero, escolaridade e demora entre a lesão e a reconstrução. Conclusão A incisão oblíqua, que apresentou menor risco de lesão nervosa, pode ser mais recomendada para a coleta do enxerto. Pacientes submetidos à reconstrução do LCA no grupo GO tiveram menor incidência de hipoestesia peri-incisional quando comparados aos pacientes do grupo GV.

Neuralgia del nervio safeno interno en pacientes operados de várices esenciales en miembros inferiores / Neuralgia of the Internal Saphenous Nerve in Patients Operated on for Essential Varicose Veins of the Lower Limbs

Introducción: La neuralgia del nervio safeno interno, possafenectomía, constituye la expresión natural de una lesión nerviosa de tipo troncular periférico y constituye un síndrome clínico frecuente pero poco estudiado desde todos los puntos de vista. Objetivo: Valorar la neuralgia del safeno interno en los pacientes operados de várices esenciales en miembros inferiores. Método: Se realizó un estudio descriptivo- retrospectivo en 60 pacientes operados (stripping o flebo-extracción) en el servicio de Angiología y Cirugía Vascular del Hospital Docente Clinicoquirúrgico "General Freyre de Andrade" con el diagnóstico de várices esenciales en los miembros inferiores y presencia de neuralgia del nervio safeno interno. El estudio se realizó de enero a diciembre de 2017. Las variables estudiadas fueron: sexo, localización de la safenectomía (izquierda, derecha, bilateral), presencia de neuralgia en el nervio safeno interno. Se trabajó con valores de frecuencias absolutas y relativas. Resultados: 40 por ciento de las safenectomías fueron bilaterales; 31,6 por ciento en miembro inferior derecho y 28,3 por ciento en el miembro inferior izquierdo. El 80 por ciento eran mujeres (25 por ciento lado izquierdo, 25 por ciento lado derecho y 50 por ciento bilateral) y el 20 por ciento hombres (58,3 por ciento lado derecho y 41,7 por ciento lado izquierdo). Pacientes con neuralgia del safeno interno 23,3 por ciento (41,7 por ciento hombres y 18,8 por ciento mujeres). Conclusión: El reconocimiento adecuado de la neuralgia del safeno interno permite excluir otras complicaciones de tipo vascular y establecer medidas profilácticas para evitarla(AU)

Introduction: Post-saphenectomy neuralgia of the internal saphenous nerve is the natural expression of a peripheral truncal nerve injury and constitutes a frequent clinical syndrome; however, it is rarely studied, from all points of view. Objective: To assess neuralgia of the internal saphenous nerve in patients operated on for essential varicose veins of the lower limbs. Method: A descriptive-retrospective study was carried out in 60 surgically intervened patients (stripping or phlebo-extraction) in the angiology and vascular surgery service of Freyre de Andrade Clinical-Surgical Teaching Hospital for a diagnosis of essential varicose veins of the lower limbs and manifestation of neuralgia of the internal saphenous nerve. The study was carried out from January to December 2017. The variables studied were sex, location of the saphenectomy (left, right, or bilateral), and manifestation of neuralgia in the internal saphenous nerve. We worked with absolute and relative frequency values. Results: 40 percent of the saphenectomies were bilateral, 31.6 percent were performed in the lower right limb, and 28.3percent corresponded to the lower left limb. 80 percent were women (left side: 25 percent, right side: 25 percent, and bilateral: 50 percent) and 20 percent were men (right side: 58.3 percent, and left side: 41.7 percent). Patients with neuralgia of the internal saphenous never accounted for 23.3 percent (41.7 percent were men and 18.8 percent were women). Conclusion: The correct identification of neuralgia of the internal saphenous nerve allows to exclude other vascular complications and to establish prophylactic measures to avoid it(AU)

Anatomical study of the infrapatellar branch of the saphenous nerve with applications to knee surgery / Estudio anatómico de la rama infrapatelar del nervio safeno con aplicaciones a la cirugía de rodilla

The infrapatellar branch of the saphenous nerve is a cutaneous nerve that innervates the area surrounding the patella and contributes to the peripatellar plexus. This nerve is target to iatrogenic injuries during a great deal of knee procedures, such as tendon harvesting, total knee arthroplasty and medial arthroscopic approaches to the knee. Lesion to this nerve can produce sensorial loss at its innervation territory. The study conducted herein aims to observe the anatomical aspects of the infrapatellar branch in cadaveric specimens. The infrapatellar branch of the saphenous nerve of 40 male cadavers was dissected with the purpose of identifying the number of branches, its relation with the patella, tibial tuberosity and sartorius muscle. The nerve was dissected and several measurements were performed with the aid of a digital caliper. Statistical analysis was performed with the MedCalc 16.1 software. The infrapatellar branch of the saphenous nerve was present in 100 % of the sample. Its mean distance from its origin to its branching point was 16.35±6.48 mm on the right and 21.94±4.31 mm on the left, with statistically significant differences (p < 0.05). A relatively safe zone for surgery was observed on the superior and medial aspect of the patella, which received less branches.

La rama infrapatelar del nervio safeno es un nervio cutáneo que inerva el área que rodea la patela y contribuye al plexo peripatelar. Este nervio es objeto de lesiones iatrogénicas durante una gran cantidad de procedimientos de rodilla, como la extracción de tendones, la artroplastía total de rodilla y los abordajes artroscópicos mediales de la rodilla. La lesión de este nervio puede producir pérdida sensorial en su territorio de inervación. El estudio realizado aquí tiene como objetivo observar los aspectos anatómicos de la rama infrapatelar en muestras de cadáveres. La rama infrapatelar del nervio safeno de 40 cadáveres masculinos se disecó con el propósito de identificar el número de ramas, su relación con la patela, la tuberosidad tibial y el músculo sartorio. Se disecó el nervio y se realizaron varias mediciones con la ayuda de un calibrador digital. El análisis estadístico se realizó con el software MedCalc 16.1. La rama infrapatelar del nervio safeno estaba presente en el 100 % de las muestras. La distancia media desde su origen hasta su punto de ramificación fue de 16,35±6,48 mm a la derecha y de 21,94±4,31 mm a la izquierda, con diferencias estadísticamente significativas (p <0,05). Se identificó una zona relativamente segura para la cirugía en el aspecto superior y medial de la patela, que recibió menos ramas.

Clinical application of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction / 中华显微外科杂志

Objective To explore the operative technique and clinical results of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction.Methods From January,2016 to June,2018,9 patients suffered from soft tissue defect were treated by the posterior tibial artery perforator flap containing saphenous nerve branch.Seven patients were males and 2 were females,with age ranged from 31 to 62 years.Soft tissue defects located in hands in 5 patients,plantar in 2 patients,ankle in 1 patient and dorsal foot in 1 patient.The size of soft tissue defects ranged from 8.0 cm×2.5 cm to 21.0 cm×4.0 cm.The regular post-operative followed-up was performed.Results All flaps survived without complications.The size of flap ranged from 10.0 cm×3.5 cm-23.0 cm×5.0 cm.Donor sites were primarily closed in 5 patients and secondary closed in 4 patients.Followed-up ranged from 6 to 15 months with 10 months in average.The contour of flaps were satisfied and the sensory function of the donor sites were normal.At 6 months followed-up,SW test reached 5.07 in all flaps,and 2PD ranged from 14 to 35 mm.Conclusion The novel sensory flap can provide satisfied sensory outcome without sacrificing main artery and saphenous nerve,and is a good candidate for sensory reconstruction of soft tissue defects.

Morphology of saphenous nerve in cadavers: a guide to saphenous block and surgical interventions / 대한해부학회지

The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. The average distance of origin of saphenous nerve from inguinal crease was 7.89±1.42 cm, the distance from upper end of medial border of patella to saphenous nerve at that level was 8.11±0.85 cm, distance from tibial tuberosity was 7.53±0.98 cm and from midpoint of anterior border of medial malleolus was 0.45±0.14 cm. Saphenous nerve provided two infrapatellar branches at the level of mid to lower limit of patellar ligament in 90% cases. It was in close contact or adhered to great saphenous vein across the lower 2/3rd of leg lying either anterior, posterior or deep to the vein. The saphenous nerve terminated by bifurcating proximal to medial malleolus in majority of cases though no obvious bifurcation was observed in 9.52% cases. The detailed morphology, relations and the distances from palpable bony landmarks may be helpful for clinicians to achieve successful saphenous nerve block and to avoid saphenous nerve damage and related complications during orthopedic procedures.

Clinical effect of anchorage of saphenous nerve on repairing medial collateral ligament injury of knee joint / 中国医师进修杂志

Objective To evaluate the clinical effect of protecting the saphenous nerve with the suture anchor on repairing the medial collateral ligament injury of the knee joint. Methods From June 2014 to June 2016, 48 cases of medial collateral ligament injuries of the knee joint were repaired with suture anchors of the saphenous nerve in the 107th Hospital of PLA. Results All patients were followed up for 12-18 months, with an average of 14.6 months. All the patients were followed up with good stability of the knee joint. The 30 degree flexion stress test of the knee joint showed that 2 cases were positive forⅠdegree, and the stress test of the extension position was negative. The X-ray examination showed that the internal and external articular space of the knee joint was symmetrical and good, and the anchors did not loose or move in the bone. The average knee flexion before operation was (43.19 ± 2.60)°, and 1 year after operation was (135.62 ± 3.68) °. And the flexion of knee 1 year after operation was higher than that before operation (t=5.37, P<0.01). The Lysholm score was (43.19 ± 2.60) points before operation, and 1 year after operation was (93.69 ± 5.39) points, and the postoperative score was higher than that before operation (t=4.85, P<0.01). The grade of efficacy was excellent in 42 cases, good in 4 cases, fair in 2 cases, and the excellent and good rate was 95.8％(46/48). Conclusions The repair of medial collateral ligament injury with suture anchors under the protection of the hidden nerve can effectively prevent the symptoms of numbness in the medial area of the knee joint. It is simple, fixed and can be repaired under direct vision. It is reliable to restore the strength of the ligament and maintain the stability of the medial knee joint. It is worthy of clinical push and wide application.

Application of ultrasound-guided continuous saphenous nerve block combined with multimodal analgesia for rehabilitation after total knee arthroplasty / 临床麻醉学杂志

Objective To compare the effect of continuous saphenous nerve block (SNB)with femoral nerve block (FNB)under multimodal analgesia for early analgesic effect and rehabilitation af-ter total knee replacement (TKA).Methods Sixty patients scheduled to undergo TKA,23 males and 37 females,were randomly divided into two groups:group A (continuous SNB)and group B (contin-uous FNB ).The patients received PCA after surgery by the catheter placed near nerve with ultrasound-guided.The loading dose was 0.5% ropivacaine 25 ml and 0.1 mg epinephrine,back-ground dose was 5 ml/h,bolus dose was 5 ml and the locking time was 20 min.The first time to walk and total steps,the knee joint range of motion,postoperative hospital stay,general anesthetics and additional analgesics dose and the side effects were also recorded.Results The first time to walkand walking distancein group A were better than group B [(25.4±2.1)h vs (34.0±2.7)h,(7.6±1.8) steps vs (3.7±1.3)steps,(P<0.05)].The range of motion in group A was bigger than in group B [12 h:(75.8±4.3)°vs (65.4±4.7)°,24 h:(93.3±4.2)°vs (81.8±4.3)°,48 h:(102.1±4.1)° vs (95.1±2.6)°,P<0.05].The average length of postoperative hospital stay was shorter in group A than in group B [(5.3±1.2)d vs (7.4±1.4)d,P<0.05].The additional analgesics and the side effects were similar between the two groups.Conclusion The continuous SNB combined with multi-modal analgesia was more beneficial to patients with the early postoperative rehabilitation for TKA.

Application of the saphenous nerve emerging site through the adductor canal in ultrasound-guided adductor canal block / 临床麻醉学杂志

Objective To study clinical data retrospectively and demonstrate the optimal injection site of adductor canal block by performing a cadaveric study.Methods Clinical part:clinical data from 19 patients,11 males and 8 females,aged 21 85 years,ASA physical status Ⅰ-Ⅲ,who received ultrasound guided adductor canal block were retrospectively collected.Among whom 9 received a mid-distance injection of 10 ml of 0.5％ ropivacaine and 10 received an injection of the same medication at the outlet of adductor canal.The primary endpoint was complete absence of cold sensation to ice cube on the medial side of calf at 30 minutes and 24 hours after injection.Cadaveric part:40 lower limbs,20 males and 20 females,were finally analyzed in the study.The distances from the anterior superior iliac spine (ASIS) to the medial tibial condyle,from ASIS to the entrance of the adductor canal,from ASIS to the exit of the canal (adductor tendinous opening),from ASIS to the site where sa phenous nerve emerges through the aponeurotic covering were measured respectively.The length of adductor canal,the relative location of adductor canal and the site where saphenous nerve pierces in the lower limbs were calculated.Results Clinical part:all 19 cases were successfully recorded with complete absence of cold sensation at 30 minutes after injection of local anesthetic and complete sensory recovery at 24 hours after injection.Cadaveric part:in all specimens,saphenous nerve enters adductor canal and coursed down until emerging at very close to the distal end of the canal with the saphenous branch of descending genicular artery.The length of the adductor canal was (10.0±2.1) cm.The entrance and the exit of adductor canal and the emerging site of the saphenous nerve located along the (54.7±3.0) ％,(76.0％±3.8) ％ and (74.1±3.2) ％ of sartorius muscle,respectively.Conclusion Performing ultrasound-guided adductor canal block at either the outlet of adductor canal or mid-distance of thigh can achieve comparable blockade of saphenous nerve.Cadaveric study implicated that the optimal injection site for adductor canal block should be the lower one-third of sartorius muscle.Ultrasound-guided injection of local anesthetics next to the descending genicular artery may possibly become a promising new method of saphenous nerve block.

Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty

Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.

A study on the effect of great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap / 中国医师进修杂志

Objective To explore the effect of great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap. Methods Fifty-two patients with skin and soft tissue lost on ankle received neoplasty using distally crural saphenous neurocutaneous pedicled skin flap. The patients were divided into two groups: the patients in interruption group (25 patients) were treated with great saphenous vein interruption on distally saphenous neurocutaneous pedicled skin flap, the patients in conventional group (27 cases) were treated without saphenous vein interruption. Results Primary healing: 15 patients (55.56%, 15/27) in conventional group, 21 patients (84.00%,21/25) in interruption group. With effusion: 17 patients (62.96%,17/27) in conventional group, 7 patients(28.00%,7/25) in interruption group. With venous crisis: 10 patients (37.04%,10/27) in conventional group, 2 patients (8.00%,2/25) in interruption group. There was statistical significance between two groups on the above 3 indexes (P 0.05). Conclusions Great saphenous vein interruption could relieve swelling, reduce effusion and have higher primary healing rate in neoplasty using distally crural saphenous neurocutaneous pedicled skin flap compared with the conventional method, which greatly reduce the pain and medical expenses of the patients.

Hind limb sensory innervation in rats: comparison between sural and saphenous nerve morphometry / Inervación sensorial de los miembros posteriores en ratas: comparación morfométrica entre los nervios sural y safeno

Although numerous studies investigate sensory recovery of the hind paw of the rat after nerve damage, still no comprehensive overview of its normal innervation is present in the literature. We investigated the morphometry of myelinated fibers in the sural and saphenous nerves and analyzed their size distributions in young rats. Six 30-day-old female Wistar rats were perfused with 2.5% glutaraldehyde and their right and left sural and saphenous nerves were prepared for light microscopy and morphometry. Morphometric data were compared between segments (proximal versus distal) and sides (right versus left) for the same nerves. Also, segments from right or left sides were compared between nerves (sural versus saphenous). Both, the sural and saphenous nerves, exhibited proximal to distal symmetry on both sides as well as left-right symmetry. Histograms of the diameter of the myelinated fibers were unimodal in both nerves, regardless of segments or sides with the peaks of the fibers size occurring between 2.5 and 4.0 µm. The axon distributions reflected the myelinated fiber distributions, with the sural and saphenous nerves peaking between 1.5 and 2.0 µm. The G ratio (the ratio between the axon and fiber diameters) distributions were also unimodal, with peaks at 0.6 for both nerves. This study contributes to the literature with information on the myelinated fibers morphometry from the two sensory nerves responsible for the rat hind limb innervation. This information is valuable for a better understanding of the possible contribution of collateral sprouting from the sural or saphenous nerves on the paw sensory territory recovery observed after one of these nerves is damaged.

Aunque numerosos estudios investigan la recuperación sensorial del miembro pélvico o posterior de la rata después del daño en los nervios, aún no existe en la literatura una visión global de su inervación normal. Investigamos la morfometría de fibras mielínicas de los nervios sural y safeno y analizamos sus distribuciones de tamaño en ratas jóvenes. Seis ratas Wistar de 30 días de edad fueron perfundidas con 2,5% de glutaraldehído, se prepararon los nervios sural y safeno derecho e izquierdo para microscopía de luz y morfometría. Datos morfométricos fueron comparados entre los segmentos (proximal vs distal) y laterales (derecho vs izquierdo) para los mismos nervios. Además, los segmentos de los lados derecho e izquierdo se compararon entre los nervios (sural vs safeno). Ambos nervios sural y safeno exhibieron una simetría proximal a distal en ambos lados, así como una simetría izquierda-derecha. Histogramas del diámetro de las fibras mielinizadas eran unimodales en ambos nervios, independientemente de los segmentos o de los lados, siendo los peaks del tamaño de las fibras entre 2,5 y 4,0 micras. Las distribuciones de los axones reflejan las distribuciones de fibras mielinizadas, de los nervios sural y safeno que alcanzaban entre 1,5 and 2,0 µm. La relación de G (relación entre los diámetros de los axones y de fibra) eran también unimodales, alcanzando 0,6 para ambos nervios. Este estudio contribuye a la literatura con los datos de la morfometría de fibras mielinizadas de ambos nervios sensoriales responsables de la inervación de la extremidad pélvica de la rata. Esta información es valiosa para una mejor comprensión de los nervios sural y safeno en la recuperación sensorial del miembro después de que uno de estos nervios ha sido dañado.

Evaluation of surgical methods and outcome of the treatment for varicose veins.

Background: Varicose veins of lower extremities are the most common peripheral vascular disease and it calls for treatment due to the morbidity and loss of working hours it causes. In advocating surgery the need to establish the need for surgery in the patient cannot be over emphasized. In the present study, the various surgical methods available and the outcome of the treatment for varicose veins in patients were evaluated. Methods: The study was conducted in teaching & general hospital and government general hospital, attached to medical college. The various available surgical procedures were used in the present study after the informed consent from all the patients. Results: Trendelenburg’s operation was done in 4.76% of cases, it was coupled with stripping of long saphenous and subfascial ligation of perforators 33.33% cases. In 9.52% cases with competent saphenofemoral junction, only subfascial ligation was carried out by small transverse incisions. Postoperative wound infection was seen in 20.59% of cases. Conclusion: Our study revealed that the Trendelenburg’s operation is carried out in all the patients with saphenofemoral incompetence. Stripping of the long saphenous vein from above downwards is safer for the saphenous nerve than stripping from below upwards. Stripping of long saphenous vein till the below knee level is an adequate procedure. This can be combined with the multiple ligation or excision of varicose tributaries.

Pattern and modes of presentation of varicose veins of lower limbs.

Background: Varicose veins of the lower extremities are one of the most common peripheral vascular diseases and calls for treatment. Therefore the present study was undertaken to study the pattern and various modes of presentation of the patient with varicosities of the lower limbs. Methods: The study was conducted in teaching & general hospital and government general hospital, attached to medical college. A detail clinical history was taken and a thorough clinical examination was done. The signs and symptoms of patients were reported. Results: 42 cases were afflicted with varicose veins of the lower extremities comprising only 10.99% of the total admissions with vascular complaints. Maximum incidence was in the age group 21-40 years (61.9%). 57.14% of cases were involved in occupation requiring prolonged periods of standing and/ or violent muscular contraction. The most common presenting complaint was pain which varied from dragging pain to night cramps associated with heaviness of the limbs. Edema was present in 11 cases, predominantly localized to below knee with pitting nature. Conclusion: Our study revealed that the disease is most prevalent in the 2nd and 3rd decades of life. We concluded that occupation involving prolonged standing and/or violent muscular contractions contribute to or precipitate varicose veins if not actually cause them.

Effects of the sural nerve and saphenous nerve nutrient vascular island flaps in repairing pediatric ankle or foot soft tissue defect / 中华医学美学美容杂志

Objective To investigate the clinical effects of the sural nerve and saphenous nerve nutrient vascular island flaps in repairing pediatric ankle or foot soft tissue defect.Methods From June 2009 to January 2013,19 cases of heel soft tissue defect were collected in hospitalized children,in which 10 cases of ankle or foot soft tissue defects were repaired with reversed sural nerve nutrient vascular island flaps and 9 cases with ankle or foot soft tissue defects with reversed saphenous nerve nutrient vascular island flaps.The skin defect areas were from 3 cm× 5 cm～5 cm× 13 cm.Results All neurocutaneous vascular flaps survived after transplantation,the wound of donor area and recipient area healed,and texture and color of flap were good.The postoperative follow-up for 3-30 months (an average 14 months) showed no secondary infection,sensory recovery for S3-S4,texture and color were similar to normal skin,and the limb shape and function were satisfactory.Conclusions The sural nerve and saphenous nerve nutrient vascular island flaps are reliable of blood supply,which do not damage the main vessel,and could reconstruct feeling.Such flaps are ideal to repair foot or ankle soft tissue defects.

Intravascular Papillary Endothelial Hyperplasia in Foot Adherent to a Saphenous Nerve Branch: A Case Report / 대한족부족관절학회지

Intravascular papillary endothelial hyperplasia (IPEH) has appeared in the literature under a variety of names, including Masson's tumor, Masson's hemangioma, and Masson's pseudoangiosarcoma. It is a benign lesion of the skin and subcutaneous tissue characterized by reactive proliferation of vascular endothelial cells with papillary formations. The clinical picture is not specific and the lesion resembles malignant angiosarcoma clinically and histopathologically. Therefore, it is often mistaken for angiosarcoma and a group of other benign and malignant vascular lesions. We report on a case of IPEH adherent to peripheral nerve treated with operative excision.

Sartorial branch of saphenous nerve: anatomical relationship with bony landmarks and great saphenous vein / Ramo sartorial del nervio safeno safeno: relación anatómica con puntos de referencia óseos y de la vena safena magna

Sartorial branch of saphenous nerve (medial crural cutaneous nerve) originates at the medial side of the knee and descends along the great saphenous vein (GSV) to innervate the medial aspect of the leg. Its anatomy is of concern in surgical procedures and anesthetic block. However, the measurement data related to palpable bony landmarks with comparison between sexes and sides are lacking. Dissection was done in 95 lower limbs from both sexes. We found that the nerve pierced the deep fascia alone in most cases (92.6%). This piercing point was always distal to the adductor tubercle with the distance of 5-6 cm which was 15% of the leg length (the distance between the adductor tubercle and medial malleolus). The nerve was 7 cm medial to the tibial tuberosity. At the mid-level of leg length, the nerve was slightly over 4 cm medial to the anterior tibial margin. The nerve terminally divided 7 cm proximal to the medial malleolus. Furthermore, the anatomical relationship between the nerve and the GSV was highly variable. The nerve was constantly anterior, posterior or deep to the GSV in 8.4%, 15.8% and 2.1%, respectively. Crossing between the two structures was observed in 57.9% of specimens and the distance to the medial malleolus was 18 cm. Symmetry was found in most parameters and significant gender differences were observed in some distances. These results are important for avoiding the sartorial nerve injury and locating the nerve during relevant procedures.

El ramo sartorial del nervio safeno (nervio cutáneo medial de la pierna) se origina en el lado medial de la rodilla y desciende a lo largo de la vena safena magna (VSM) para inervar la cara medial de la pierna. Su anatomía es motivo de preocupación en los procedimientos quirúrgicos y en el bloqueo anestésico. Sin embargo, los datos de medición relacionados con puntos de referencia óseos palpables y la comparación entre los lados y en ambos sexos son escasas. Se realizó la disección en 95 miembros inferiores de ambos sexos. Se encontró que el nervio perforó la fascia profunda en la mayoría de los casos (92,6%). Esta punta de perforación fue siempre distal al tubérculo del músculo aductor magno a una distancia de 5-6 cm, que representaba el 15% del largo de la pierna (la distancia entre el tubérculo del aductor magno y el maléolo medial). El nervio se localizaba 7 cm medial a la tuberosidad tibial. Al nivel del tercio medio en ambas piernas, el nervio estaba a una distancia un poco mayor a 4 cm medial al margen anterior de la tibia. El nervio se dividía 7 cm proximal al maléolo medial. Por otra parte, la relación anatómica entre el nervio y la VSM fue muy variable. El nervio era constantemente anterior, posterior o profundo a la VSM en 8,4%, 15,8% y 2,1%, respectivamente. Cruce entre las dos estructuras anatómicas se observó en el 57,9% de las muestras y la distancia hasta el maléolo medial fue de 18 cm. La simetría se encuentra en la mayoría de los parámetros y diferencias de sexo significativas se observaron en algunas distancias. Estos resultados son importantes para evitar la lesión del nervio sartorial y localizar el nervio durante los procedimientos pertinentes.

The retention of the great saphenous vein below-knee decreases saphenous nerve injury during varicose veins surgery / 中华普通外科杂志

Objective To evaluate selective retention of the great saphenous vein (GSV) belowknee in the prevention of saphenous nerve injury during varicose veins surgery.Methods From January 2009 to January 2012,280 consecutive patients with incompetence of the GSV resulting in varicose veins were prospectively randomized into 2 groups.Patients in the experimental group underwent stripping restricted to the below knee level,patients in control group underwent GSV stripping to the ankle level Patients in the two groups were treated with transilluminated powered phlebectomy,and foam sclerotherapy.Primary end points were postoperative pain,saphenous nerve injury,quality of life and recurrence rate.Results After one month follow-up:5.71％ patients had symptoms of nervous system in the observation group,14.29％ patients had symptoms of nervous system in the control group (P =0.02).After 1 year follow-up,1.47％ patients had symptoms of nervous system in the observation group,7.14％ patients had symptoms of nervous system in the control group (P =0.02).Conclusions Selective retention of great saphenous vein below-knee decreases saphenous nerve injury.

Clinical research on repairing large area soft tissue defects in heel and crus by flaps with double blood-supply of posterior tibial artery perforators and saphenous nerve nutrient vessels / 中华显微外科杂志

Objective To summarize the curative effect of repairing large area soft tissue defects in heel and crus by flaps with double blood-supply of posterior tibial artery perforators and saphenous nerve nutrient vessels.Methods From January 2006 to February 2012,twenty cases took operation under the guide of Continuous Wave Doppler and design of tibial artery perforator as rotation point.And in all cases,island flaps with the blood supply from saphenous nerve nutrient vessels and tibial artery perforator were retained to repair large area soft tissue defects in heel and crus.In operations,the range of flap area were ranged from 19 cm × 11 cm to 11 cm × 8 cm.Skin flaps incision was up to the patella margin level,low to medial malleolus on edge,former to crus former median line,rear to after crus median line and farthest to the surface of wound on the metatarsophalangeal joint.Results Nineteen cases survived,and 1 case of skin flap mild necrosis at the farthest side took a second-phase line skin flap to repair.Followed-up from 6 months to 24 months was taken in all cases at the mean time of 10 months,with a result of good recovery and no ulceration for the flaps.To varying degree,all flaps recover sense of pain and deep touch.Conclusion There is no wound to posterior main tibial artery in repairing large area soft tissue defects in heel and crus by flaps with double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels,meanwhile to maintain double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels and expand the range of blood supply of posterior tibial artery perforators.In this operation,a blood circulation for the flap can be guaranteed so as for a large wound in heel and crus.

Sonoanatomic Variation of Pes Anserine Bursa

BACKGROUND: The pes anserine bursa lies beneath the pes anserine tendon, which is the insertional tendon of the sartorius, gracilis, and semitendinosus muscles on the medial side of the tibia, but it can lie in different sites in the medial knee. Accurate diagnosis of the position of the bursa is critical for diagnostic and therapeutic goals. The aim of this study was to evaluate sonoanatomic variations of the pes anserine bursa in the medial knee. METHODS: One hundred seventy asymptomatic volunteers were enrolled in this study. Using ultrasound imaging (transverse approach, 7-13 MHz linear array probe) the sonoanatomic position of the pes anserine bursa and its relation to the pes anserine tendon were evaluated. Additionally, we evaluated the sonoanatomic variation of the saphenous nerve. RESULTS: The position of the pes anserine bursa was between the medial collateral ligament and the pes anserine tendons in 21.2%/18.8% (males/females) of subjects; between the pes anserine tendons and the tibia in 67.1%/64.7% (m/f); and among the pes anserine tendons in 8.2%/12.9% (m/f). No significant differences in the position of the bursa existed between males and females. The saphenous nerve was found within the pes anserine tendons in 77.6%/74.1% (m/f) of subjects, but outside the pes anserine tendons in 18.8%/15.3% (m/f). Visibility of sonoanatomic structures was not related to either gender or BMI. CONCLUSIONS: Ultrasound provides very accurate information about variations in the pes anserine bursa and the saphenous nerve. This suggests that our proposed ultrasound method can be a reliable guide to facilitate approaches to the medial knee for diagnostic and therapeutic objectives.