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  • Endoscopic assisted harvesting of sural nerve graft

    Final Number:

    Ashraf M. Hassan MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Sural nerve harvesting is one of the most commonly practiced procedures in peripheral nerve surgery. Particularly in brachial plexus surgery or in multiple peripheral nerve injuries, the entire sural nerve and sometimes both sural nerves are harvested and sectioned into multiple cables to match the diameter of the recipient nerve. Classically a longitudinal incision along the sural nerve course is used, leaving a long and unpleasant scar particularly in young children as well as significant postoperative pain and discomfort. Here we present an alternative endoscopic assisted way to harvest the sural nerve through 2 small transverse incisions, each is about one inch long.

    Methods: 15 sural nerves were harvested in 12 patients using SSI endoscopic assisted harvesting system originally designed to harvest saphenous vein grafts for cardiac surgery.The system is composed of a hand-held retractor with built in port for a 4 mm telescope, a 40 cm fenestrated grasper and a 40 cm endoscopic microscissor. The course of the sural nerve is marked, 2 one inch transverse incisions are placed at the junction between the lower and middle thirds and between the middle and upper thirds of the nerve. The 2 incisions are carried down to the fascia, which is opened and sural nerve identified below the fascia, the hand-held retractor is tunneled below the fascia then the fenestrated grasper is used to hold the nerve within its fenestrum without any compression and the microscissor is used to separate the nerve from the undersurface of the fascia. Visual analogue score for postoperative pain, pain medication consumption and length of hospital stay were evaluated for the 15 sides and compared to historical controls in whom the nerve graft was obtained in the classic way.

    Results: Endoscopic assisted harvesting of sural nerve graft resulted in a superior cosmetic outcome, less postoperative pain and less postoperative pain medications usage and a similar postoperative hospital stay.

    Conclusions: In our experience, endoscopic assisted sural nerve graft harvesting is a superior alternative to the classic way

    Patient Care: Less postoperative pain Less pain medications Better cosmetic results

    Learning Objectives: To know the technique of endoscopic assisted sural nerve harvesting To learn the better clinical outcome


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