Abstract
To investigate variations regarding the formation and course of the sural nerve (SN). We dissected 60 formalin-fixed Brazilian fetuses (n = 120 lower limbs) aged from the 16th to 34th weeks of gestational age. Three incisions were made in the leg to expose the SN, and the gastrocnemius muscle was retracted to investigate the SN course. Statistical analyses regarding laterality and sex were performed using the Chi-square test. Eight SN formation patterns were classified after analysis. Type 4 (in which the SN is formed by the union of the MSCN with the LSCN) was the most common SN formation pattern. Although there was no statistical association between the formation patterns and the lower limb laterality (p = 0.9725), there was as to sex (p = 0.03973), indicating an association between anatomical variation and sex. The site of branch joining was in the distal leg most time (53.75%). In all lower limbs, the SN or its branches crossed from the medial aspect of the leg to the lateral margin of the calcaneal tendon (CT). Most often, the SN is formed by joining the MSCN and the LSCN in the distal leg. The SN or its branches ran close to the saphenous vein, crossed the CT from medial to lateral, and distributed around the lateral malleolus.
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References
Olave E, Cruzat C, Retamal P, Galaz C (2010) Formación del Nervio Sural en Individuos Chilenos. Int J Morphol 28:273–276
Aktan Ikiz ZA, Uçerler H, Bilge O (2005) The anatomic features of the sural nerve with an emphasis on its clinical importance. Foot Ankle Int 26:560–567. https://doi.org/10.1177/107110070502600712
Kavyashree AN, Lakshmi Prabha S, Asha KR, Bindu Rani MK (2013) Anatomical variations in formation of sural nerve in adult Indian cadavers. J Clin Diagnostic Res 7:1838–1841. https://doi.org/10.7860/JCDR/2013/6633.3328
Zhu J, Li D, Shao J, Hu B (2011) An ultrasound study of anatomic variants of the sural nerve. Muscle Nerve 43:560–562. https://doi.org/10.1002/mus.21918
Desdicioglu K, Malas MA, Bahceci S, Simsek F, Polat AG (2017) Anatomical and histological morphometry of the sural nerve in human fetuses. J Anat Soc India 66:37–42. https://doi.org/10.1016/j.jasi.2017.05.005
Eid EM, Hegazy AMS (2011) Anatomical variations of the human sural nerve and its role in clinical and surgical procedures. Clin Anat 24:237–245. https://doi.org/10.1002/ca.21068
Popieluszko P, Mizia E, Henry BM, PĘkala PA, Sanna B, Roy J, Loukas M, Tomaszewski KA (2018) The surgical anatomy of the sural nerve: An ultrasound study. Clin Anat 31:450–455. https://doi.org/10.1002/ca.22997
Seema SR (2013) Study of sural nerve complex in human cadavers. ISRN Anat 2013:827276. https://doi.org/10.5402/2013/827276
Ulcay T, Uzun A (2018) Anatomical variations of the formation of human sural nerve in stillborns. J Anat Soc India 67:50–54. https://doi.org/10.1016/j.jasi.2018.04.001
Mahakkanukrauh P, Chomsung R (2002) Anatomical variations of the sural nerve. Clin Anat 15:263–266. https://doi.org/10.1002/ca.10016
Kammar H, Carmont MR, Kots E, Laver L, Mann G, Nyska M, Mei-Dan O (2014) Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination. Orthopedics 37:e298-301. https://doi.org/10.3928/01477447-20140225-64
Nieto JL, Vergara Amador E, Amador JA (2009) Sural nerve: anatomical study and clinical aspects. Colomb Med 40:252–258. https://doi.org/10.25100/cm.v40i3.653
Park J-H, Park K-R, Kim D, Kwon H-W, Lee M, Choi Y-J, Kim Y-B, Park S, Yang J, Cho J (2019) The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study. J Orthop Surg Res 14:356. https://doi.org/10.1186/s13018-019-1411-7
Apaydin N, Bozkurt M, Loukas M, Vefali H, Tubbs RS, Esmer AF (2009) Relationships of the sural nerve with the calcaneal tendon: an anatomical study with surgical and clinical implications. Surg Radiol Anat 31:775–780. https://doi.org/10.1007/s00276-009-0520-0
Choi H, Chung SY, Kang S, Son S-H, Yoon JS (2019) Could Ultrasound-Guided Stimulation of Sural Nerve Affect Nerve Conduction Study? Ann Rehabil Med 43:74–80. https://doi.org/10.5535/arm.2019.43.1.74
Büyükmumcu M, Aydin Kabakçi AD, Akin Saygin D, Yilmaz MT, Şeker M (2021) Sural nerve harvest for infants: Integrated with information based on anatomical dissections. Turkish J Med Sci 51:473–482. https://doi.org/10.3906/sag-2005-225
Kumar GP, Kumar UK (1994) Estimation of Gestational Age from Hand and Foot Length. Med Sci Law 34:48–50. https://doi.org/10.1177/002580249403400106
Iwanaga J, Singh V, Takeda S, Ogeng’o J, Kim H-J, Moryś J, Ravi KS, Ribatti D, Trainor PA, Sañudo JR, Apaydin N, Sharma A, Smith HF, Walocha JA, Hegazy AMS, Duparc F, Paulsen F, Del Sol M, Adds P, Louryan S, Fazan VPS, Boddeti RK, Tubbs RS (2022) Standardized statement for the ethical use of human cadaveric tissues in anatomy research papers: Recommendations from Anatomical Journal Editors-in-Chief. Clin Anat 35:526–528. https://doi.org/10.1002/ca.23849
Shield LK, King RH, Thomas PK (1986) A morphometric study of human fetal sural nerve. Acta Neuropathol 70:60–70. https://doi.org/10.1007/BF00689515
Mestdagh H, Drizenko A, Maynou C, Demondion X, Monier R (2001) Origin and make up of the human sural nerve. Surg Radiol Anat 23:307–312. https://doi.org/10.1007/s00276-001-0307-4
Dangintawat P, Huanmanop T, Agthong S, Chentanez V (2016) Anatomy of the Sural Nerve Related to Calcaneal Tendon, Intermalleolar Line and Small Saphenous Vein. Int J Morphol 34:380–384. https://doi.org/10.4067/s0717-95022016000100055
Nuri T, Ueda K, Maeda S, Otsuki Y (2012) Anatomical study of medial and lateral sural cutaneous nerve: implications for innervated distally-based superficial sural artery flap. J Plast Surg Hand Surg 46:8–12. https://doi.org/10.3109/2000656X.2011.644720
Pyun SB, Kwon HK (2008) The effect of anatomical variation of the Sural nerve on nerve conduction studies. Am J Phys Med Rehabil 87:438–442. https://doi.org/10.1097/PHM.0b013e318174e569
Ugrenovic S, Vasovic L, Jovanovic I, Stefanovic N (2005) Peculiarities of the sural nerve complex morphologic types in human fetuses. Surg Radiol Anat 27:25–29. https://doi.org/10.1007/s00276-004-0276-5
Sekiya S, Suzuki R, Miyawaki M, Chiba S, Kumaki K (2006) Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses. Anat Sci Int 81:84–91. https://doi.org/10.1111/j.1447-073x.2006.00135.x
Jeon SK, Paik D-J, Hwang Y-I (2017) Variations in sural nerve formation pattern and distribution on the dorsum of the foot. Clin Anat 30:525–532. https://doi.org/10.1002/ca.22873
Shankar N, Selvam RP, Dhanpal N, Reddy R, Alapati A (2010) Anatomical variations of the sural nerve in the leg: a fetal study. Neurol India 58:24–28. https://doi.org/10.4103/0028-3886.60390
Albay S, Sakalli B, Kastamoni Y, Candan IA, Kocabiyik N (2012) Formation of the sural nerve in foetal cadavers. Folia Morphol (Warsz) 71:221–227
Park H-D, Kwak H-H, Hu K-S, Han S-H, Fontaine C, Kim H-J (2007) Topographic and histologic characteristics of the sural nerve for use in nerve grafting. J Craniofac Surg 18:1434–1438. https://doi.org/10.1097/scs.0b013e3181534a4d
Porter KJ, Robati S, Karia P, Portet M, Szarko M, Amin A (2014) An anatomical and cadaveric study examining the risk of sural nerve injury in percutaneous Achilles tendon repair using the Achillon device. Foot Ankle Surg 20:90–93. https://doi.org/10.1016/j.fas.2013.11.005
Tankisi H, Pugdahl K, Otto M, Fuglsang-Frederiksen A (2014) Misinterpretation of sural nerve conduction studies due to anatomical variation. Clin Neurophysiol 125:2115–2121. https://doi.org/10.1016/j.clinph.2014.01.030
Uluutku H, Can MA, Kurtoglu Z (2000) Formation and location of the sural nerve in the newborn. Surg Radiol Anat 22:97–100. https://doi.org/10.1007/s00276-000-0097-0
Acknowledgements
We thank Alisson Correia (ORCID ID: 0000-0002-7599-5124) for his dedication and commitment to this project, which enabled us to go international with our paper. Thank you, Alisson, for your contributions throughout this process.
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Garção, D.C., de Souza Paiva, M.S. & Corcinio, K.S. Variations in sural nerve formation and course in fetuses. Neurosurg Rev 46, 189 (2023). https://doi.org/10.1007/s10143-023-02098-x
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DOI: https://doi.org/10.1007/s10143-023-02098-x