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Complications of endovenous ablation of varicose veins
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
The risk of nerve injury during EVTA is directly related to the relative proximity of several nerves to the most commonly ablated veins. The saphenous nerve, the largest cutaneous branch of the femoral nerve, travels along the path of the superficial femoral artery from the groin to the knee. It innervates the skin of the medial surface of the calf and the medial surface of the foot. Hence, damage to the saphenous nerve usually causes sensory loss on the medial aspect of the calf, above the medial malleolus. The main saphenous nerve pierces the deep fascia just above the knee and becomes superficial at the level of the knee between sartorius and gracilis muscles. It becomes more superficial below the knee and runs alongside the long saphenous vein. At the popliteal fossa, it travels medially and approximates the GSV at the level of the upper calf to the level of the ankle, where it splits into two branches. It is at greatest risk of injury in the mid- to distal calf. EVTA is thus usually performed up to the level of the knee excluding patients with significant venous reflux in the below-knee saphenous vein. Injury to the saphenous nerve causes a cutaneous paresthesia, which is usually transient.
Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Saphenous nerve: arises from the base of the femoral triangle and descends the leg towards the ankle, remaining lateral to the femoral artery. It remains in the adductor canal in the thigh and emerges between the gracilis and sartorius muscles before descending down the medial border of the tibia, just behind the great saphenous vein. At the medial malleolus, the saphenous nerve crosses to be in front of the vein.
Pre-, intra-, and post-treatment use of duplex ultrasound (thermal and non-thermal)
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
The four nerves that come into play most often with regard to phlebologic procedures are the saphenous nerve, the sural nerve, the tibial nerve, and the common peroneal nerve. The saphenous nerve is a sensory nerve relating to the medial calf, ankle, and foot. Murakami et al. [21] reported on the anatomical relationship of the saphenous vein and the saphenous nerve (Figure 9.23), indicating that these two ran intimately together in 59% in the middle third of the leg and 83% in the lower third of the leg. In addition, more than half of those in the lower third of the leg showed an “adhesive relationship where the epineurium of the saphenous nerve was seen histologically to be attached to adventitia of vein” [21]. Historically, with vein stripping, Masaki et al. [22] reported that 4.9% of GSV strippings result in nerve injury, and full-length stripping accounted for almost 40% of all cases. Therefore the relationship is well established and should be recognized and safeguarded when using newer thermal approaches.
Letter to the Editor
Published in The Neurodiagnostic Journal, 2021
Regarding validity of results. The authors conduct statistical analysis that finds no link between the success of DSn-SSEP stimulation and other factors such as sex, age, BMI, MAP, MAC, diagnosis, and the presence or absence of quadriceps TcMEPs or tibial nerve SSEPs. However, this analysis is performed after removing 14 out of 100 subjects and does not factor in wide-ranging stimulation parameters. Removing 14 of the 100 subjects (13 of whom quadriceps TcMEPs were not present), the authors reported DSn-SSEP success rate falls from 87% to 75% and eliminates the possibility of an anesthetic effect being detected (requested 0.5 MAC but received mean of 0.7 MAC). A wide range of stimulation parameters of 300–1000 µs pulse width, 20–100 mA, and different stimulation needle lengths (13 mm to 19 mm) are cited, but the authors do not disclose or factor these parameters into their analysis. These wide ranging parameters could be a significant variable. Case report style data is also reported. It appears these case(s) is included to prove that the saphenous nerve, not the proximal tibial nerve, is being activated, but the number of patients and which stimulation parameters were used are not stated.
Great toe drop following knee ligament reconstruction: A case report
Published in Physiotherapy Theory and Practice, 2020
David A Boyce, Chantal Prewitt
Arthroscopy knee surgery for anterior cruciate ligament (ACL) reconstruction is a minimally invasive and commonly performed outpatient procedure. Recent data have indicated that from 1996 to 2006 knee arthroscopic procedures increased by 46% (Kim et al., 2011). In 2014, Salzler et al. (2014) reported a 4.7% complication rate following knee arthroscopic procedures between 2002 and 2008. Though postsurgical complication rates can be as high as 8%, neurologic injuries resulting from knee arthroscopy are uncommon (Allum, 2002; Johnson, Sharma, and Bangash, 1999). Several studies have reported nerve injury incidence after knee arthroscopy to be between 0.06% and2.5% (Sanders, Rolf, McClelland, and Xerogeanes, 2007; Small, 1986, 1988). The saphenous nerve was the most commonly injured (42%) followed by the common fibular nerve (CFN) (5%) (Small, 1986).
Sensory neurotization of muscle: past, present and future considerations
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Steven D. Kozusko, Alexander J. Kaminsky, Louisa C. Boyd, Petros Konofaos
One of the critical clinical examples of sensory neurotization was reported by Bain et al. [15] in 2008. They presented a case of a patient with a sciatic nerve palsy after undergoing total hip arthroplasty. Three months post-operatively, the patient underwent sensory nerve transfer in order to protect the gastrocnemius and tibialis anterior muscles from atrophy until proximal regeneration of his damaged nerve could occur. The end points for the study were activities of daily living and electrophysiological measurements of recovery, both of which improved. The saphenous nerve was used to neurotize the medial and lateral heads of the gastrocnemius as well as the tibialis anterior muscle. An individual nerve fascial from the saphenous nerve was coapted to the distal nerves in an ETS technique. Below the knee the only muscles that had evidence of recovery were those that were neurotized. One year after surgery the patient had ankle dorsiflexion returning through the tibialis anterior. Furthermore, fibrillations were decreasing in this muscle and compound motor action potentials were increasing. This case study sets the stage for future clinical studies in sensory neurotization.