Pediatric Sural Nerve Harvest: a Fully Endoscopic Technique

Objective: The sural nerve has long been a favorite for peripheral nerve repair. Traditional "stocking seam" and "stair-step" harvest techniques both have serious drawbacks, including unsightly scarring with contractures occasionally leading to equinovarus deformities, long operative time, and poor quality and length of graft. Our objective was to develop a truly endoscopic method of sural nerve harvest using 1 small incision and 1 stab incision.

Methods: An endoscope designed for harvesting vascular conduits was used for nerve graft dissection. The nerve was then cut through a stab incision below the popliteal fossa. Sural nerve harvest was performed on 3 pediatric patients, aged 5 months to 3.5 years, between October and December of 2007.

Results: Nerve graft lengths were 9.5 to 13 cm. The mean operative time was 18 minutes from incision to graft removal and 36 minutes from incision to dressing placement. During all procedures, the brachial plexus exploration proceeded unimpeded during the graft harvest. Under microscopic inspection, the nerve grafts were much less damaged than those harvested previously with the stair-step technique. There were no complications during a mean follow-up period of 3 months.

Conclusion: Advantages over previously described techniques include: 1) reduction from three or four 1.5-cm incisions to one 1.5-cm incision and one 3-mm incision, 2) a significant decrease in operative time, 3) increased ease of performing the graft harvest simultaneously with the brachial plexus dissection, and 4) a notable improvement in the graft, both in length and appearance.