OBJECTIVE: To determine anatomical variation of the sural nerve (SN) by ultrasonography (US) and compare sensory nerve action potential (SNAP) of the SN obtained by a control method to that obtained with adjusted method using US. METHODS: Eighty legs of 40 healthy volunteers were enrolled. The location and formation of SN were investigated through US. Two methods of nerve conduction study (NCS) were then performed. In the control method, the cathode was placed 14 cm proximal to the lateral malleolus and the greatest SNAP amplitude was obtained by moving the cathode medially or laterally from just lateral to the calf-mid line. In adjusted NCS, the exact SN union site was stimulated in type 1. In other SN types, the stimulation was done directly over the nerve and the distance from the lateral malleolus was set to be 14 cm. RESULTS: It was found that 73.8% of the SNs were type 1, 22.5% were direct continuation of MSCN (type 2), and 3.8% were MSCN and LSCN without communicating (type 4). However, type 3 was not found. The union point in type 1 SN was 12.6±2.5 cm proximal to the lateral malleolus and 1.4±0.7 cm lateral to the calf-midline. After stimulation adjustment, SNAP amplitude in type 1 SN was significantly increased (20.7±5.5 μV vs. 27.1±6.7 μV). CONCLUSION: Anatomical variation of SN and its location were verified by US. US provides additional information for conducting sural NCS and helps obtain more accurate results.
Action Potentials ; Electrodes ; Healthy Volunteers ; Leg ; Methods ; Neural Conduction ; Sural Nerve ; Ultrasonography

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.
Arteries ; Bandages ; Estrogens, Conjugated (USP) ; External Fixators ; Free Tissue Flaps ; Heel ; Humans ; Immobilization ; Leg Injuries ; Lower Extremity ; Perforator Flap ; Sural Nerve ; Surgical Flaps ; Tissue Donors ; Wounds and Injuries

OBJECTIVE: To explore clinical effects of ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures. METHODS: From January 2015 to March 2017, 20 patients with acute closed Achilles tendon rupture were treated by minimal traverse-cross technique repair with ultrasound guided. Among them, including 13 males and 7 females, aged from 28 to 49 years old with an average of(31.3 ±4.5) years old. All patients were single side injury. Fifteen patients on the left side and 5 patients were on the right side. The time from injury to operation ranged from 1 to 5 days with an average of (2.5±0.7) days. Operative time, postoperative complications were observed, and AOFAS score before and after operation at 12 months were compared. RESULTS: All patients were followed up for 12 to 27 months with an average of(15.2±4.9) months. Operative time ranged from 33 to 65 min with an average of(43.7±5.6) min. Incision of one patient were continued oozing and improved after changing dressings, other patients were healed at stage I. No sural nerve irritation symptoms and palindromic rapture of heel tendon occurred. AOFAS score was improved from 65.2±7.4 before operation to 97.7±4.7 after operation at 12 months (t=22.5, <0.01); 18 patients got excellent results and 2 good. CONCLUSIONS Ultrasound-guided minimal traverse-cross technique repair for acute closed Achilles tendon ruptures, which promise minimal incision, protect sural nerve, ensure quality of tendon anastomosis and fixation, and is a ideal method for repairing acute closed Achilles tendon ruptures.
Achilles Tendon ; Adult ; Female ; Humans ; Male ; Middle Aged ; Rupture ; Sural Nerve ; Sutures ; Tendon Injuries ; Treatment Outcome

Nearly one third of the world's population have active or latent tuberculosis, resulting in 1.5 million deaths annually. Tuberculosis involving the peripheral nerve is difficult to detect. Sural nerve tuberculoma is an extremely rare case of tuberculous involvement of the peripheral nerve that has attracted the attention of physicians. This paper reports a patient with sural nerve tuberculoma. A 58-year-old female patient presented with a palpable mass on the posterolateral calf with progressive tingling sensation on the distal area. The patient had no history of trauma and it was unclear whether the patient had any contact with individuals with active tuberculosis. The histopathologic findings revealed a granuloma-like lesion with caseous necrosis that was compatible with tuberculoma.
Female ; Humans ; Latent Tuberculosis ; Middle Aged ; Necrosis ; Peripheral Nerves ; Sensation ; Sural Nerve ; Tuberculoma ; Tuberculosis

BACKGROUND: Cross-facial nerve graft is considered the treatment of choice for facial reanimation in patients with unilateral facial palsy caused by central facial nerve damage. In most cases, a traditional parotidectomy skin incision is used to locate the buccal and zygomatic branches of the facial nerve. METHODS: In this study, cross-facial nerve graft with the sural nerve was planned for three patients with facial palsy through an intraoral approach. RESULTS: An incision was made on the buccal cheek mucosa, and the dissection was performed to locate the buccal branch of the facial nerve. The parotid papillae and parotid duct were used as anatomic landmarks to locate the buccal branch. CONCLUSIONS: The intraoral approach is more advantageous than the conventional extraoral approach because of clear anatomic marker (parotid papilla), invisible postoperative scar, reduced tissue damage from dissection, and reduced operating time.
Anatomic Landmarks ; Cheek ; Cicatrix ; Facial Nerve ; Facial Paralysis ; Humans ; Mucous Membrane ; Skin ; Sural Nerve ; Transplants

PURPOSE: This study compared the clinical outcomes of open repair, percutaneous repair, and minimal incision repair by Achillon in ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with open repair (group 1), 8 patients with percutaneous repair (group 2), and 10 patients with minimal incision repair by Achillon (group 3) from February 2013 to March 2016 were analyzed retrospectively. The postoperative clinical evaluations were done by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Arner-Linholm scale, mid-calf circumference difference, one-leg heel raise difference, visual analogue scale (VAS) for postoperative scarring, time to return to work, and complications. RESULTS: No significant difference in the AOFAS ankle-hindfoot score, Arner-Linholm scale, and time to return to work was observed among three groups (p=0.968, 0.509, and 0.585). The mean differences in the mid-calf circumference in groups 1, 2, and 3 were 1.09, 0.73, and 0.58, respectively; groups 2 and 3 were significantly higher than group 1 (p=0.002). In addition, the mean VAS scores for postoperative scarring in groups 1, 2, and 3 were 7.0, 9.1, and 9.1, respectively; groups 2 and 3 were significantly higher than group 1 (p=0.001). The mean differences in one-leg heel raising in groups 1, 2, and 3 were 2.03, 1.91, and 1.33, respectively; group 3 was significantly higher than groups 1 and 2 (p=0.010). The complications encountered were one case of deep infection in group 1 and one case of sural nerve hypoesthesia in group 2. CONCLUSION: Minimal incision repair by Achillon is recommended as an effective surgical treatment for Achilles tendon rupture because it minimizes the risk of complications, leads to an improved tendon strength and healing, and achieves cosmetic satisfaction.
Achilles Tendon* ; Ankle ; Cicatrix ; Foot ; Heel ; Humans ; Hypesthesia ; Retrospective Studies ; Return to Work ; Rupture* ; Sural Nerve ; Tendons

A hypertrophied peroneal tubercle can present as a bony prominence at the lateral aspect of the foot and a peroneal tenosynovitis or tear. We report a case of a 52-year-old man complaining of lateral foot tingling pain and numbness. The sural nerve entrapment and peroneus longus tenosynovitis by hypertrophied peroneal tubercle were confirmed. Good results were obtained after excision of the hypertrophied peroneal tubercle and sural nerve release.
Calcaneus ; Foot ; Humans ; Hypesthesia ; Middle Aged ; Sural Nerve* ; Tears ; Tenosynovitis*

BACKGROUND: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.
Diabetes Mellitus, Type 2* ; Diabetic Neuropathies ; Diagnosis ; Humans ; Hyperesthesia ; Hypesthesia ; Linear Models ; Male ; Mass Screening ; Methods ; Michigan ; Neural Conduction* ; Peripheral Nervous System Diseases ; Phenotype* ; Retrospective Studies ; Sensory Thresholds ; Sural Nerve

PURPOSE: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. RESULTS: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p < 0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. CONCLUSION: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.
Achilles Tendon* ; Ankle ; Cicatrix ; Foot ; Heel ; Humans ; Orthopedics ; Retrospective Studies ; Rupture ; Sural Nerve ; Ultrasonography

OBJECTIVE: Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). METHODS: We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups: group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. RESULTS: Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. CONCLUSION: Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.
Animals ; Methods ; Muscles ; Neural Cell Adhesion Molecules ; Peripheral Nerves ; Rats ; Rats, Sprague-Dawley ; Skin ; Sural Nerve* ; Tibial Nerve*