Abstract
As an alternative to autologous nerve donors, acellular nerve allografts (ANAs) have been studied in many experiments. There have been numerous studies on processing ANAs and various studies on the clinical applications of ANA, but there have not been many studies on sources of ANAs. The purposes of the present study were to evaluate the course of the saphenous and sural nerves in human cadavers and help harvest auto- or allografts for clinical implications. Eighteen lower extremities of 16 fresh cadavers were dissected. For the saphenous nerve and sural nerve, the distances between each branch and the diameters at the midpoint between each branch were measured. In the saphenous nerve, the mean length between each branch ranged from 7.2 to 28.6 cm, and the midpoint diameter ranged from 1.4 to 3.2 mm. In the sural nerve, the mean length between each branch ranged from 17.4 to 21 cm, and the midpoint diameter ranged from 2.3 to 2.8 mm. The present study demonstrates the length of the saphenous and sural nerve without branches with diameters larger than 1 mm. With regard for the clinical implications of allografts, the harvest of a selective nerve length with a large enough diameter could be possible based on the data presented in the present study.
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References
Andersen HL, Andersen SL, Tranum-Jensen J (2015) The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study. Acta Anaesthesiol Scand 59:238–245. https://doi.org/10.1111/aas.12451
Brooks DN, Weber RV, Chao JD et al (2012) Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions. Microsurgery 32:1–14. https://doi.org/10.1002/micr.20975
Brushart TM (1988) Preferential reinnervation of motor nerves by regenerating motor axons. J Neurosci 8:1026–1031. https://doi.org/10.1523/JNEUROSCI.08-03-01026.1988
Carlson TL, Wallace RD, Konofaos P (2018) Cadaveric nerve allograft: single center’s experience in a variety of peripheral nerve injuries. Ann Plast Surg 80:S328–S332. https://doi.org/10.1097/sap.0000000000001470
Cho MS, Rinker BD, Weber RV, Chao JD, Ingari JV, Brooks D, Buncke GM (2012) Functional outcome following nerve repair in the upper extremity using processed nerve allograft. J Hand Surg Am 37:2340–2349. https://doi.org/10.1016/j.jhsa.2012.08.028
Evans PJ, Mackinnon SE, Levi AD, Wade JA, Hunter DA, Nakao Y, Midha R (1998) Cold preserved nerve allografts: changes in basement membrane, viability, immunogenicity, and regeneration. Muscle Nerve 21:1507–1522. https://doi.org/10.1002/(SICI)1097-4598(199811)21:11%3c1507:AID-MUS21%3e3.0.CO;2-W
Griffith CK, Miller C, Sainson RC, Calvert JW, Jeon NL, Hughes CC, George SC (2005) Diffusion limits of an in vitro thick prevascularized tissue. Tissue Eng 11:257–266. https://doi.org/10.1089/ten.2005.11.257
Hoben G, Yan Y, Iyer N, Newton P, Hunter DA, Moore AM, Sakiyama-Elbert SE, Wood MD, Mackinnon SE (2015) Comparison of acellular nerve allograft modification with Schwann cells or VEGF. Hand (N Y) 10:396–402. https://doi.org/10.1007/s11552-014-9720-0
Hudson TW, Liu SY, Schmidt CE (2004) Engineering an improved acellular nerve graft via optimized chemical processing. Tissue Eng 10:1346–1358. https://doi.org/10.1089/ten.2004.10.1641
Ide C, Tohyama K, Yokota R, Nitatori T, Onodera S (1983) Schwann cell basal lamina and nerve regeneration. Brain Res 288:61–75. https://doi.org/10.1016/0006-8993(83)90081-1
Isaacs J, Browne T (2014) Overcoming short gaps in peripheral nerve repair: conduits and human acellular nerve allograft. Hand (N Y) 9:131–137. https://doi.org/10.1007/s11552-014-9601-6
Isaacs J, Safa B (2017) A preliminary assessment of the utility of large-caliber processed nerve allografts for the repair of upper extremity nerve injuries. Hand (N Y) 12:55–59. https://doi.org/10.1177/1558944716646782
Kim J, Lee YH, Kim MB, Rhee SH, Baek GH (2014) Anatomy of the direct small branches of the proper digital nerve of the fingers: a cadaveric study. J Plast Reconstr Aesthet Surg 67:1129–1135. https://doi.org/10.1016/j.bjps.2014.04.026
Mercer D, Morrell NT, Fitzpatrick J, Silva S, Child Z, Miller R, DeCoster TA (2011) The course of the distal saphenous nerve: a cadaveric investigation and clinical implications. Iowa Orthop J 31:231–235. https://doi.org/10.2165/11540000-000000000-00000
Moradzadeh A, Borschel GH, Luciano JP, Whitlock EL, Hayashi A, Hunter DA, Mackinnon SE (2008) The impact of motor and sensory nerve architecture on nerve regeneration. Exp Neurol 212:370–376. https://doi.org/10.1016/j.expneurol.2008.04.012
Neubauer D, Graham JB, Muir D (2007) Chondroitinase treatment increases the effective length of acellular nerve grafts. Exp Neurol 207:163–170. https://doi.org/10.1016/j.expneurol.2007.06.006
Rbia N, Shin AY (2017) The role of nerve graft substitutes in motor and mixed motor/sensory peripheral nerve injuries. J Hand Surg Am 42:367–377. https://doi.org/10.1016/j.jhsa.2017.02.017
Rinker B, Zoldos J, Weber RV, Ko J, Thayer W, Greenberg J, Leversedge FJ, Safa B, Buncke G (2017) Use of processed nerve allografts to repair nerve injuries greater than 25 mm in the hand. Ann Plast Surg 78:S292–S295. https://doi.org/10.1097/sap.0000000000001037
Sondell M, Lundborg G, Kanje M (1998) Regeneration of the rat sciatic nerve into allografts made acellular through chemical extraction. Brain Res 795:44–54. https://doi.org/10.1016/S0006-8993(98)00251-0
Tang P, Kilic A, Konopka G, Regalbuto R, Akelina Y, Gardner T (2013) Histologic and functional outcomes of nerve defects treated with acellular allograft versus cabled autograft in a rat model. Microsurgery 33:460–467. https://doi.org/10.1002/micr.22102
Wang D, Liu XL, Zhu JK, Jiang L, Hu J, Zhang Y, Yang LM, Wang HG, Yi JH (2008) Bridging small-gap peripheral nerve defects using acellular nerve allograft implanted with autologous bone marrow stromal cells in primates. Brain Res 1188:44–53. https://doi.org/10.1016/j.brainres.2007.09.098
Wang F, Zhou D, Li W, Ge M, Zhu D (2017) A new pattern of the sural nerve added to “anatomy of the sural nerve: cadaver study and literature review. Plast Reconstr Surg Glob Open 5:e1628. https://doi.org/10.1097/gox.0000000000001628
Zhu Z, Zhou X, He B, Dai T, Zheng C, Yang C, Zhu S, Zhu J, Zhu Q, Liu X (2015) Ginkgo biloba extract (EGb 761) promotes peripheral nerve regeneration and neovascularization after acellular nerve allografts in a rat model. Cell Mol Neurobiol 35:273–282. https://doi.org/10.1007/s10571-014-0122-1
Zuo J, Hernandez YJ, Muir D (1998) Chondroitin sulfate proteoglycan with neurite-inhibiting activity is up-regulated following peripheral nerve injury. J Neurobiol 34:41–54. https://doi.org/10.1002/(SICI)1097-4695(199801)34:1%3c41:AID-NEU4%3e3.0.CO;2-C
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The authors disclose receipt of experimental support by Korea Public Tissue Bank (KPTB). This article was edited by a professional English language editing service, Nature Research Editing Service.
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Im, JH., Lee, JY., Yeon, WH. et al. The anatomy of the saphenous and sural nerves as a source of processed nerve allografts. Cell Tissue Bank 21, 547–555 (2020). https://doi.org/10.1007/s10561-020-09841-4
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DOI: https://doi.org/10.1007/s10561-020-09841-4