Harvesting of the Sural Nerve with a Tendon Stripper

The nerve most commonly used for peripheral nerve reconstruction is the sural nerve. The nerve can be dissected free through one long calf incision, by utilizing multiple small incisions, or by using a tendon stripper. We studied 12 above-knee amputation specimens harvesting the nerve in the ways described. We found that the length of nerve harvested averaged 32, 36, and 25 cm for the open, limited open, and stripper techniques, respectively. Epineurial damage occurred with the stripper, but no perineurial damage was documented histologically. We concluded that the closed method (stripper) of harvesting sural nerve would provide quality graft material, but of unpredictable length. When reliably long segments of nerve are required, at least a limited open or an open approach for harvest is recommended.