Predicting Nerve Course Variations to Prevent Iatrogenic Lesions: A Surgical Perspective on Sural Nerve Variations

Area of Science:

• Anatomy
• Surgical Anatomy
• Lower Limb Anatomy

Background:

• The sural nerve exhibits numerous documented variations in anatomical literature.
• Surgical approaches necessitate awareness of the sural nerve's course for either direct management or avoidance.

Purpose of the Study:

• To provide a surgical perspective on sural nerve variations.
• To inform surgical planning regarding the sural nerve in lower limb procedures.

Main Methods:

• Dissection of 25 preserved cadaveric lower limbs from the popliteal fossa to the foot.
• Analysis of sural nerve course at three defined anatomical locations (proximal, mid-shaft fibula, and near distal fibula).
• Documentation and comparison of observed sural nerve variations with existing literature.

Main Results:

• The sural nerve was observed at an average distance of 4.6 cm posterior to the fibula proximally and mid-shaft, and 4.5 cm distally.
• Observed variations in the 25 dissected specimens were not consistent with previously published findings.
• Highlights a significant abundance of sural nerve variations requiring clinical and surgical attention.

Conclusions:

• Sural nerve anatomical data can aid in preoperative planning.
• Informed surgical decisions regarding addressing or avoiding the sural nerve in the posterior superficial compartment of the leg are facilitated.
• Emphasizes the need for surgeons to be prepared for diverse sural nerve presentations.