Sensory and functional morbidity following sural nerve harvest in paediatric patients

Publication date: Available online 3 August 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Joseph Catapano, Mark Shafarenko, Emily S. Ho, Ronald M. Zuker, Gregory H. Borschel

Summary

Background

The sural nerve is a common donor site for nerve reconstruction. The only study describing outcomes in paediatric patients was following bilateral sural nerve harvest prior to the age of one. Bilateral nerve harvest at such a young age may limit patients' ability to perceive a sensory difference. The objective of this study was to understand the sensory and functional deficit after unilateral sural nerve harvest in paediatric patients.

Methods

A prospective case series was performed in children (age 6 to 18) following unilateral sural nerve harvest. The contralateral foot was used as a control. Sensory Threshold Evaluation was performed using Weinstein Enhanced Sensory Test (WEST) – Foot and a Functional Sensory and Pain Questionnaire was administered. Sural nerve harvest was performed using a minimally invasive technique using a nerve stripper.

Results

Twenty-eight feet of fourteen patients that underwent unilateral sural nerve harvest were assessed. As a group, the fourteen feet with sural nerve harvest demonstrated significantly higher thresholds in the four areas tested (p < 0.05), identifying objective sensory loss at each location. The location of sensory loss in each patient was variable with heavier sensory thresholds detected in 69.6 % of areas tested in comparison to the corresponding location in the contralateral foot. Greater sensory loss was detected at the proximal lateral foot in comparison to the distal lateral foot. Responses to the questionnaire revealed that only one patient perceived a sensory loss that affected their function.

Conclusions

Unilateral sural nerve harvest in paediatric patients results in measurable sensory loss. Despite loss of innervation, only two patients reported intermittent dysesthesia or cold-sensitivity and the majority of patients report no functional deficit.