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The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study
Jeong-Hyun Park1, Kwang-Rak Park1, Digud Kim1
1Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea.
Background:
The skin incision for medial displacement calcaneal osteotomy (MDCO) often damages the sural nerve. We aimed to identify the practical reference area in which the surgeon can incise the skin to minimize the injury of the sural nerve during MDCO.
Methods:
The foot and ankles of 20 cadavers were dissected. The landmarks were the following four anatomical references: point A, the tip of the lateral malleolus; point B, the inferior margin of the calcaneus on the vertical line through point A; point C, the posteroinferior apex of the calcaneus; and point D, the lateral border of the Achilles tendon on the horizontal line through point A. The distances from the sural nerve to points A and B in the vertical direction (lines D1 and D2, respectively), to points A and C in the diagonal direction (lines D3 and D4, respectively), and to points A and D in the horizontal direction (lines D5 and D6, respectively) were measured.
Results:
The median ratios of D1 to D1+D2, D3 to D3+D4, and D5 to D5+D6 were 0.34 (range 0.25 to 0.45), 0.23 (range 0.16 to 0.33), and 0.38 (range 0.26 to 0.50), respectively.
Conclusions:
The distance ratios according to easily identifiable references would be a more practical incision strategy for surgeons to minimize sural nerve injury in both open and minimally invasive/percutaneous MDCO.
Insights
Surgeons can minimize sural nerve injury during medial displacement calcaneal osteotomy (MDCO) by using specific anatomical landmarks for skin incisions. This study provides practical reference areas to guide surgical cuts and prevent nerve damage.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Surgical Neurology
Background:
- Medial displacement calcaneal osteotomy (MDCO) is a common orthopedic procedure.
- The sural nerve is at risk of iatrogenic injury during the skin incision for MDCO.
- Identifying safe surgical corridors is crucial for preventing nerve damage.
Purpose of the Study:
- To determine precise anatomical reference points for skin incision during MDCO.
- To minimize the risk of sural nerve injury in patients undergoing MDCO.
Main Methods:
- Dissection of 20 cadaveric feet and ankles.
- Measurement of distances between the sural nerve and defined anatomical landmarks (lateral malleolus, calcaneus margins, Achilles tendon).
- Calculation of distance ratios to establish safe incision zones.
Main Results:
- Median distance ratios were calculated for vertical, diagonal, and horizontal planes relative to anatomical landmarks.
- Specific ratios (e.g., 0.34 for vertical, 0.23 for diagonal, 0.38 for horizontal) indicate safe zones.
- The results provide quantitative data on sural nerve proximity to potential incision sites.
Conclusions:
- Distance ratios based on easily identifiable anatomical references offer a practical strategy for surgeons.
- This approach can reduce sural nerve injury during both open and minimally invasive MDCO.
- The findings support improved surgical planning and patient safety in calcaneal osteotomies.
