Saphenous nerve transfer: A new approach to restore sensation of sole

Publication date: Available online 2 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Pawan Agarwal, Piyush Shukla, D Sharma

Abstract

Background

Loss of protective sensation in the sole may lead to repeated trauma, chronic non healing ulcers and even amputation. Saphenous Nerve (SN) to Posterior Tibial Nerve (PTN) transfer can provide restoration of sensation in sole.

Method

This study was conducted in a tertiary referral center in Central India. Twenty one patients (32 feet) diagnosed with loss of sensation of sole were included in this study. Causes were Hansen's disease (n=18), complex sciatic nerve injury (n=1) lumbosacral spinal tumor (n=1) and lumbosacral meningo-myelocoel (n=1). Seventeen feet (14 patients) had ulcers on sole. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration and two-point discrimination. Results were classified as per British Medical Research Council (MRC) scoring system.

Results

17 patients (26 feet) were available for follow-up at 6 months after surgery. All patients had improvement in sensory parameters. Ulcers completely healed in 13 feet and reduced in size in 4 feet. MRC score improved from S0 in 22 feet and S1 in 10 feet to S3+ in 20 feet, S3 in 4 feet and S2 in 2 feet.

Conclusions

Sensory neurotization with SN transfer to PTN can restore protective sensation to the sole and helps in healing of ulcers.