Surgical anatomy of the saphenous nerve

During harvest of the saphenous vein (SV), the most important relationship to take into account is the saphenous nerve (SN) to avoid pain and paresthesias after surgery.

We harvested the SV and SN in 20 cadaveric lower limbs. Relationships between both structures were recorded using a millimetric ruler, and distances were measured from the medial malleolus at the ankle.

The SV was superficial to the leg fascia 32 cm above the malleolus in 95% of the legs. During its course in the leg, 40% of SNs are posterior to the SV; 40% are anterior and then posterior to the SV; and 10% are posterior and then hidden by the SV. The SN crosses the SV in 55% of the legs. Three constant branches of the SN were identified: middle-posterior, middle-anterior, and inferior-anterior. The SN ends by splitting 5.9 cm above the malleolus. A vulnerable region occurs in the lowest 13.2 cm, where the SN adheres to the SV. At this level the SN gives off the inferior-anterior branch that crosses the SV in 66% of the legs. Between 21.6 cm and 28.8 cm the SN crosses deep to the SV.

During harvest of the SV, the most vulnerable area is the inferior third of the leg because of venonervous adhesion.