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Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus.
J Anat. 2001 Dec; 199(Pt 6):717-23.JA

Abstract

The aim of this study was to investigate the risk and to analyse the significance of laceration of the sural and superficial fibular nerves during the surgical approach to the lateral malleolus. The sural and the superficial fibular nerves, and their branches were dissected under x 3 magnifying lenses in 68 embalmed leg-ankle-foot specimens. The specimens were measured, drawn and photographed. In 35% of specimens the superficial fibular nerve branched before piercing the crural fascia, and in all these specimens the medial dorsal cutaneous nerve of the foot was located in the anterior compartment while the intermediate dorsal cutaneous nerve of the foot was located in the lateral compartment. In 35% of specimens the intermediate dorsal cutaneous nerve of the foot was absent or did not innervate any toe. The deep part of the superficial fibular nerve was in contact with the intermuscular septum. Its superficial part was parallel with the lateral malleolus when the nerve pierced the fascia more proximally and oblique to the lateral malleolus when the nerve pierced the fascia distally. In one case the intermediate dorsal cutaneous nerve of the foot was in danger of laceration during a subcutaneous incision to the lateral malleolus. In 7 cases (10%) the sural nerve overlapped or was tangent to the tip of the malleolus. Malleolar nerve branches were identified in 76% of the cases (in 28% from both sources). The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. Our study indicates that during the approach to the lateral malleolus there is a high risk of laceration of malleolar branches from both the sural and the superficial fibular nerves. There is less risk of damage to the main trunk of these nerves, but the 10% chance of laceration of sural nerve at the tip of the malleolus is significant. As the sural nerve supplies the superficial innervation to the lateral half of the foot and toes in 40% of cases, the risk of its laceration is even more important than indicated by the common anatomical teaching.

Authors+Show Affiliations

Department of Orthopaedics, Alice Springs Hospital, NT, Australia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11787825

Citation

Solomon, L B., et al. "Surgical Anatomy of the Sural and Superficial Fibular Nerves With an Emphasis On the Approach to the Lateral Malleolus." Journal of Anatomy, vol. 199, no. Pt 6, 2001, pp. 717-23.
Solomon LB, Ferris L, Tedman R, et al. Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus. J Anat. 2001;199(Pt 6):717-23.
Solomon, L. B., Ferris, L., Tedman, R., & Henneberg, M. (2001). Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus. Journal of Anatomy, 199(Pt 6), 717-23.
Solomon LB, et al. Surgical Anatomy of the Sural and Superficial Fibular Nerves With an Emphasis On the Approach to the Lateral Malleolus. J Anat. 2001;199(Pt 6):717-23. PubMed PMID: 11787825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical anatomy of the sural and superficial fibular nerves with an emphasis on the approach to the lateral malleolus. AU - Solomon,L B, AU - Ferris,L, AU - Tedman,R, AU - Henneberg,M, PY - 2002/1/15/pubmed PY - 2002/2/16/medline PY - 2002/1/15/entrez SP - 717 EP - 23 JF - Journal of anatomy JO - J. Anat. VL - 199 IS - Pt 6 N2 - The aim of this study was to investigate the risk and to analyse the significance of laceration of the sural and superficial fibular nerves during the surgical approach to the lateral malleolus. The sural and the superficial fibular nerves, and their branches were dissected under x 3 magnifying lenses in 68 embalmed leg-ankle-foot specimens. The specimens were measured, drawn and photographed. In 35% of specimens the superficial fibular nerve branched before piercing the crural fascia, and in all these specimens the medial dorsal cutaneous nerve of the foot was located in the anterior compartment while the intermediate dorsal cutaneous nerve of the foot was located in the lateral compartment. In 35% of specimens the intermediate dorsal cutaneous nerve of the foot was absent or did not innervate any toe. The deep part of the superficial fibular nerve was in contact with the intermuscular septum. Its superficial part was parallel with the lateral malleolus when the nerve pierced the fascia more proximally and oblique to the lateral malleolus when the nerve pierced the fascia distally. In one case the intermediate dorsal cutaneous nerve of the foot was in danger of laceration during a subcutaneous incision to the lateral malleolus. In 7 cases (10%) the sural nerve overlapped or was tangent to the tip of the malleolus. Malleolar nerve branches were identified in 76% of the cases (in 28% from both sources). The sural nerve supplies the lateral 5 dorsal digital nerves in 40% of cases. Our study indicates that during the approach to the lateral malleolus there is a high risk of laceration of malleolar branches from both the sural and the superficial fibular nerves. There is less risk of damage to the main trunk of these nerves, but the 10% chance of laceration of sural nerve at the tip of the malleolus is significant. As the sural nerve supplies the superficial innervation to the lateral half of the foot and toes in 40% of cases, the risk of its laceration is even more important than indicated by the common anatomical teaching. SN - 0021-8782 UR - https://www.unboundmedicine.com/medline/citation/11787825/Surgical_anatomy_of_the_sural_and_superficial_fibular_nerves_with_an_emphasis_on_the_approach_to_the_lateral_malleolus_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0021-8782&date=2001&volume=199&issue=Pt 6&spage=717 DB - PRIME DP - Unbound Medicine ER -