Title: A clinical test to avoid sural nerve injuries in percutaneus Achilles tendon repairs
Authors: R. Flavin, R.G. Gibney, S.K. O’Rourke
Source: Injury, International Journal of the Care of the Injured. 2007; 38, 845-847
PODIATRIC RELEVANCE:
While the traditional method of percutaneous Achilles tendon rupture repair has been successful in both reapproximating the Achilles tendon and reducing the amount of wound complications associated with the open technique, it has posed another problem. The incidence of sural nerve injuries associated with the percutaneous technique, first described by Ma and Griffith, has a higher rate of occurance than that of the traditional open technique. The objective of this study was to develop a clinical technique for identifying the path of the sural nerve preoperatively.
METHODS:
In this article 10 male patients, each participating at a high sporting activity level, between the ages of 25 and 30 years old were randomly selected to evaluate the usefulness of clinically mapping the path of the sural nerve as well as comparing these results to ultrasound mapping of the sural nerve. The sural nerve was identified by placing the patients prone, flexing the knee to 90 degrees, dorsiflexing the ankle, inverting the hindfoot, and supinating the forefoot, thereby causing the sural nerve to be taut and palpable. The skin was then marked every 2 cm along the path of the sural nerve utilizing transverse markings from between the medial and lateral heads of the gastrocnemius distal to the inferior border of the lateral malleolus. A Phillips iU22 ultrasound system and a L17-5 broadband linear transducer were then utilized to visualize the sural nerve along its path with the patients’ knee in full extension to simulate the operative position. The difference between the clinical mapping and ultrasound mapping were then measured by an independent observer.reconstruction of the soft tissue defects to the tibia and quadriceps respectively.
RESULTS:
While the difference between the two methodologies were great in 1 patient with a 20mm difference, the remainder of patients showed a closer correlation with a mean distance of 2mm between the clinical mapping and the ultrasound mapping. It was noted that the ultrasound had poor sensitivity around the area of 4cm proximal to the Achilles insertion and continuing distal to its insertion.
COMMENTS:
l Although this study is limited to 25-30 year old active males with intact Achilles tendons, it does propose an ideal method to preoperatively evaluate the sural nerve location prior to percutaneous repair of Achilles tendon ruptures. Further studies may be needed to validate these findings in females and non athletic patients.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.