Endoscopic harvesting of the sural nerve graft: Technical note

Abstract

OBJECTIVE AND IMPORTANCE: The sural nerve is the donor nerve most commonly used for peripheral nerve reconstruction. The objective of this paper is to present an endoscopic technique for harvesting these sural nerve grafts, using the Guidant Vaso-View Uniport Plus device (Guidant Corp., Indianapolis, IN), originally designed to obtain the saphenous vein. The importance of this technique is its use of a small, 12-mm incision for removing the entire sural nerve, which is an improvement over the two, three, or one 3-cm incisions(s) for sural nerve harvesting described in other publications. Endoscopic techniques, in general, replace the former open technique requiring a longitudinal incision along the entire posterior lower leg, which is a distinct advantage. CLINICAL PRESENTATION: Two cases of patients with lesions requiring sural nerve grafts are presented. Nerve action potential recordings showed no transmission in each case and nerve grafts were required for repair of these lesions after their resection to healthy-appearing tissue. INTERVENTION: The first patient had a stretch contusion injury extending from the right C5 and C6 roots to the upper trunk (UT) and UT outflow to the suprascapular nerve (SSN). This patient required a sural nerve graft 20 cm in length, which was harvested by the described endoscopic technique within 20 minutes. The second patient had in continuity lesions involving the C5 and C6 roots to the UT including the SSN and the C7-middle trunk to posterior spinal cord. These lesions required a 31-cm sural nerve graft harvested via the endoscopic technique in 25 minutes. CONCLUSION: When compared with the open techniques, the endoscopic method using the Guidant VasoView Uniport Plus device has the advantages of being fast, less traumatic, safer, and resulting in a more aesthetic technique.