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Anatomy of the Sural Nerve: Cadaver Study and Literature Review

Riedl, Otto M.D., M.Sc.; Frey, Manfred M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 802–810
doi: 10.1097/PRS.0b013e3182818cd4
Reconstructive: Lower Extremity: Original Articles

Background: The sural nerve is commonly used as donor for nerve grafting. Contrary to its constant retromalleolar position, formation and course of the proximal sural nerve show great variability. The coexistence of different and deceptive terminologies contributes to the complexity, and reviewing the international literature is confusing. Because detailed anatomical knowledge is essential for efficient and safe sural nerve harvesting, this study aims to bring clarity.

Methods: Previous sural nerve reports listed in the PubMed database and established anatomical textbooks were reviewed. Different terminologies were compared and adjusted. Anatomical details and variations were noted. Subtle prospective anatomical dissections and comparison with actual data followed.

Results: Two hundred twenty-one relevant reports were identified and worked up going back to the nineteenth century. Fourteen established German and English language anatomical textbooks were reviewed. Thirty lower limbs were dissected. In total, this study pools the information of more than 2500 sural nerves.

Conclusions: This study covers all information about the sural nerve anatomy published internationally. The coexistence of different and confusing terminologies is pinpointed and adjusted to allow comparison of previous reports and to gain a coordinated data pool of more than 2500 investigated sural nerves. Detailed features are clearly described and summarized, findings from the authors' own prospective dissections complete these data, and the prior existing anatomical confusion is resolved. Finally, clinical implications are described.

Vienna, Austria

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna.

Received for publication July 28, 2012; accepted October 15, 2012.

Disclosure: The authors have no financial conflicts of interest relevant to the content of this article, and have not received funding for research on which this article is based from any organization.

Otto Riedl, M.D., M.Sc.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria,

©2013American Society of Plastic Surgeons