Study of variations in medial sural cutaneous nerve, lateral sural cutaneous nerve and peroneal communicating nerve.

The sural nerve complex includes the Medial sural cutaneous nerve (MSCN), Lateral sural cutaneous nerve (LSCN), Peroneal communicating nerve (PCN) and Sural nerve. The sural nerve is the most frequently used donor nerve for peripheral nerve grafting. LSCN can be an alternative to sural nerve in situations requiring a limited length of nerve graft material, the peroneal communicating nerve may also be harvested. Fifty lower limb specimens were dissected and data was collected. The study included 16 male and 9 female cadavers. MSCN was observed in all 50 specimens, out of which 74% specimens had normal course and 22% had a transmuscular course. LSCN was present in 82% of specimens. PCN was arising from Common Peroneal Nerve (CPN) directly in 16% and as a common trunk with LSCN in 14% of specimens. PCN was absent in 28% of cases. So knowledge of variation in these nerves will help the surgeons while considering these nerves for nerve grafting.

Clinical application of the compound muscle flap combined by the lateral sural artery perforators and the nutrient vessels of the lateral sural cutaneous nerve / 中华显微外科杂志

Objective To observe the anatomic relationship between the lateral sural artery perforators and the nutrient vessels of the lateral sural cutaneous nerve that were combined to design a compound muscle flap.And to observe the effect of this flap clinical application.Methods Ten adult and fresh cadaver lower limbs were observed the anatomic relationship between the lateral sural artery perforators and the nutrient vessels of the lateral sural cutaneous nerve,and were combined to design a compound muscle flap.Clinically applied in 5 cases,and the flap sizes ranged from 6 cm × 9 cm to 9 cm × 12 cm.Results After into the muscle,the lateral sural artery issued 3-5 perforating branches (OD:0.2-1.8 mm) along the way,which provided nutrition for the lateral head of the gastrocnemius and the surrounding skin and involved in the formation of shallow and deep fascia vascular network with the nutrient vessels of the lateral sural cutaneous nerve.From Feburary 2009 to November 2011,the compound pedicled muscle flap were clinically applied in 5 cases to repair the skin defects of the anterior knee and proximal tibia.Flaps in 4 cases completely survivedand 1 case had partial superficial necrosis on the distal part of the flap,which healed after dressing change.Conclusion The compound pedicled muscle flap has two sets of blood supply that could expand the area of the flap,which could guarantee its feeling.This kind of flap could repair the complicated skin and soft tissue defects around the knee joint.

Anatomic basis of sensation restoration of distally based island flap pedicled with nutrient vessels of superficial peroneal nerve / 中华显微外科杂志

@#Objective To provide anatomic basis for sensation restoratiou of distally based island flap pedicled with nutrient vessels of superficial peroneal nerve by use of lateral sural cutaneous nerve. Methods The origin, course and distribution rule of lateral part sensory nerve of leg were dissected and observed in 40 antisepticized adult cadaveric limbs. Results ①Lateral sural cutaneous nerve originated from common peroneal nerve 7cm above apex of fibular head, descended short distance along common peroneal nerve, then passed through pepliteal fascia to facies lateralis cruris,along the way it sent out 1-3 terminal branches, which distributed over the skin of Ⅰ , Ⅱ area in the posterior lateral leg. ②Superficial peroneal nerve originated from common peroneal nerve 1.9cm below apex of fibular head, descended forward between peroneus longus and fibula, then descended between peroneus longus and peroneus brevis, and sent out branches to the two muscles. The nerve bole (pure sensory nerve branch) descended straight between peroneus brevis and anterior cmral intermuscular septum, at the juncture between Ⅱ、Ⅲ area in facies lateralis eruris, passed through deep fascia to subcutaneous tissue, then sent out medial dorsal cutaneous nerve of foot and intermediate dorsal cutaneous nerve of foot, which distributed over the skin of dorsum of foot and Ⅲ area in facies lateralis cmris. Conclusion It may be available in sensation restoration of distally based island flap pedicled with nutrient vessels of superficial peroneal nerve through anastomosis of lateral sural cutaneous nerve bole with sensory nervous ramification of recipient site.

Anatomical Investigation of Sural Nerve and Its Contributing Nerves

OBJECTIVE: To identify the location and formation of the sural nerve and its contributing nerves. METHOD: Fourteen lower limbs of 7 adult cadavers were anatomically dissected. The location and formation of the sural nerve (SN) in relation to the medial sural cutaneous nerve (MSCN) and the lateral sural cutaneous nerve (LSCN) were investigated. The length and diameter of the SN and contributing nerves were measured and the differences of the results were analyzed. RESULTS: Twelve SNs were formed by the union of the MSCNs and LSCNs, and 2 SNs were direct extensions of the MSCNs. The point of formation of the SN by union of the MSCN and LSCN was found in the middle third of the legs in 66.7% of SNs examined. The union sites of the SNs were located at 40.58+/-13.97% of the length of lower leg from the tip of lateral malleolus and 55.84+/-6.48% of the calf width from the medial border of the calf. There were significant statistical differences of diameter among nerves (p<0.05) and no significant difference of length between MSCN and LSCN. CONCLUSION: The results of this cadaveric study would increase the accuracy of the sural nerve conduction study and provide the locational information for precise surgical approach.