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Sequelae Following Use of Sural Nerve for Nerve Reconstruction
Lars B. Dahlin, MD, PhD; Alexander Hallgren, MD; Anette Chemnitz, MD; Anders Björkman, MD, PhD;
Department of Clinical Sciences Malmö

Introduction:

The sural nerve is commonly used to create cable grafts in reconstruction of injured nerve trunks with a defect. Sequele from the lower leg are not known in detail, e.g. as related to the symptoms seen after a sural nerve biopsy. Our aim was to evaluate residual symptoms in the lower leg after harvesting the sural nerve for grafting to bridge nerve defects.

Material & Methods:

Forty-six patients, identified from the hospital administrative system, 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. The questionnaire consists of questions about loss of sensation, pain, cold intolerance, allodynia and present problems from the foot. The survey contained also questions (visual analogue scales; VAS) about disability from the reconstructed nerve trunk.

Results:

Forty-one out of 46 patients replied [35 males/6 females; age at reconstruction 23.0 years (10-72); median (min-max)], where reconstruction was done at a median of 12 (1.2-39) years ago. In most patients [37/41 cases (90%)], the sural nerve graft was used to reconstruct an injured nerve trunk in the upper extremity; mainly the median nerve [(19/41 (46 %)].

In 38/41 patients, loss of sensation, to a variable extent, in the sural nerve innervated area of the foot was noted. These problems persisted at follow up, but 19/41 noted that this area of sensory deficit had decreased over time. Few patients had pain and less than 1/3 had cold intolerance. Allodynia was present in half of the patients, but the majority of them considered that they had no or only slight problems from their foot. None of the patients in the study required painkillers. Eighty eight per cent were positive to another sural nerve graft procedure if necessary in the future.

Conclusions:

Harvest of a sural nerve to reconstruct an injured nerve trunk is a safe procedure. The remaining symptoms were mild and similar to those seen after a nerve biopsy; although nerve biopsy patients are less prone to undergo an additional biopsy.


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