American Society for Peripheral Nerve

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Donor Site Morbidity After Sural Nerve Grafting: A Systematic Review
Ravinder Bamba, MD1, Scott Nathan Loewenstein, MD2 and Joshua M Adkinson, MD1, (1)Indiana University, Indianapolis, IN, (2)Division of Plastic Surgery, Indiana University, Indianapolis, IN

Purpose: The sural nerve provides sensory information to the lateral aspect of the foot and is commonly used as a nerve graft.  Understanding the morbidity of sural nerve harvest is important when counseling patients regarding nerve graft options.  The objective of this study was to systematically review the literature and pool the current data for postoperative outcomes after sural nerve graft harvest.

Method: A systematic review of the English literature published in PubMed and MEDLINE databases was conducted to identify studies that examined donor site outcomes of patients who underwent harvest of a sural nerve graft.   The PRISMA guidelines were used to ensure study quality.

Result: Five-hundred and fourteen studies were identified through a literature search, and nine studies between 1999 and 2018 were found to meet inclusion criteria.    There were a total of 240 patients who underwent sural nerve grafts.  The average follow up was 6.9 years.  The most common method for sensory evaluation was survey evaluation (44.4%) followed by Semmes Weinstein evaluation (33.3%). Studies varied on how sensation loss, pain, cold sensitivity, and functional impairment were reported.  87.2% of patients (n=190) reported sensation loss at follow-up.  Five studies reported areas of sensory loss in patients, which decreased over time after sural nerve grafting.  25.6% (n=42) of patients reported pain at follow-up.  22.2% (n=28) of patients reported cold sensitivity at follow-up.  10% (n=20) of patients reported functional impairment at follow-up.

Conclusion: The sural nerve graft is an important tool in the armamentarium of the peripheral nerve surgeon.  However, nerve autografts are associated with donor site morbidity.  In this study we present the extent of sensory loss and rates of pain, cold sensitivity, and functional impairment after sural nerve harvest.  These data should be discussed with patients prior to surgery in order for patients and surgeons to make an informed decision.

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