• Annals of Clinical Neurophysiology
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• v.7 no.2
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• pp.97-100
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• 2005

Background: The most distal sensory fibers of the feet are often affected first in polyneuropathy. However, they are not evaluated in routine nerve conduction studies. Thus we evaluated the dorsal sural sensory nerve in patients with sensorimotor polyneuropathy with normal sural response, in order to assess the usefulness in electrodiagnostic practice. Methods: In this study, 53 healthy subjects and 27 patients with clinical evidence of sensorimotor polyneuropathy were included. In all subjects, peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. On electrodiagnostic testing, all patients had normal sural responses. Results: The dorsal sural sensory nerve action potentials (SNAPs) mean amplitude was $13.12{\pm}5.68{\mu}V$, mean latency was $3.12{\pm}0.43msec$, and mean sensory conduction velocity (SCV) was $36.50{\pm}3.40m/s$ in healthy subjects. In 7 of 27 patients, the dorsal sural nerve SNAPs were absent bilaterally, and in 20 patients, the mean dorsal sural nerve distal latency was longer($3.40{\pm}0.48ms$, P=0.006), and mean SCV was slower than in healthy subjects($35.08{\pm}4.59$, P=0.043). However, dorsal sural nerve amplitude was not different between the groups (P=0.072). Conclusions: Our findings suggest that dorsal sural nerve conduction studies should be included in the routine electrodiagnostic evaluation of patients with suspected polyneuropathy and normal sural nerve responses.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.709-715
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• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.715-722
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• 2006

Purpose: The main advantages of the perforator flap are minimal donor site morbidity, preservation of any main source artery and its thin characteristics. Most perforator flaps for hand reconstruction need primary and secondary procedures such as a flap debulkiness and liposuction etc. However, flap thickness of calf area is thinner than any other perforator flaps. Methods: We performed an anatomical study and clinical application of medial sural artery perforator flap. We found that there are two or more medial sural perforators located on a straight line drawn from the mid-point of popliteal crease to the mid-point of medial malleolus. Most pathway of medial sural artery comes along with this line. It is possible to observe the first perforators almost exactly 8 cm from midpoint of popliteal crease in a distal half circle drawn with a radius of 2 cm. Results: We report 12 cases in 11 patients of hand reconstruction with medial sural perforator free flap from Febrary 2003 to Febrary 2006. Complete healing was possible in 11 cases. Total flap loss for venous insufficiency was in 1 patient. During the follow-up, good contour and full range of motion was observed on hand reconstruction with medial sural perforator free flap. Conclusion: In the authors' experience, this anatomical study made it possible to prepare a diagram of the exact location of the medial sural perforators. This flap can be used to achieve acceptable functional and aesthetic results for hand reconstruction because of its thin characteristics.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.208-213
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• 2008

Purpose: Distally based superficial sural artery island flap has some disadvantages such as postoperative flap edema, congestion, and partial necrosis of the flap margin. Venous congestion is an area of considerable concern in distally based superficial sural artery fasciocutaneous flap and is one of the main reasons for failure, particularly when a large flap is needed. However, we could decrease these disadvantages by means of venous superdrainage. Methods: From June of 2006 to June of 2007, a total of two patients with soft tissue defects of lower one third of the leg underwent venous supercharging distally based superficial sural artery island flap transfer. The distal pivot point of this flap was designed at septocutaneous perforator from the peroneal artery of the posterolateral septum, which was 5 cm above the tip of the lateral malleolus. Briefly, this technique is performed by anastomosing the proximal end of the lesser saphenous vein and collateral vein to any vein in the area of the recipient defect site. Results: No venous congestion was noted in any of the two cases. No other recipient or donor-site complications were observed, except for minor wound dehiscence in one case. In 3 to 6 months follow-up, patients had minor complaints about lack of sensation in the lateral dorsal foot. Conclusion: The peroneal artery perforator is predictable and reliable for the design of a distally based superficial sural artery island flap. Elevation of the venous supercharging flap is safe, easy, and less time consuming. In conclusion, the venous supercharging distally based superficial sural artery island flap offers an alterative to free tissue transfer for reconstruction of the lower extremity.

• Journal of Korean Foot and Ankle Society
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• v.9 no.2
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• pp.227-230
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• 2005

Injuries to sural nerve through surgical incision or open wound in calcaneal fractures were reported as complications causing lateral hindfoot pain. But sural nerve entrapment by adhesive fibrous tissue after Essex-Lopresti axial fixation has not been reported. We report a case of sural nerve entrapment after Essex-Lopresti axial fixation which was successfully treated by nerve decompression.

• Journal of Korean Foot and Ankle Society
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• v.15 no.1
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• pp.44-46
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• 2011

Sural nerve is a sensory nerve that innervates the lateral side of ankle and foot, and the injury of this nerve can be usually caused by surgical approch of calaneal fracture or achilles tendon injury. Entrapment neuropahty of sural nerve caused by bony fragment after calcaneal fracture is not reported, yet. Authors experienced one case that sural nerve injury due to bony fragment after calcaneal fracture and we regard that it is a rare case, so we report this case after reviewing literatures.

• Journal of Korean Foot and Ankle Society
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• v.10 no.2
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• pp.179-183
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• 2006

Purpose: To review the results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration. Materials and Methods: Eleven superficial peroneal and sural nerve lesions in eleven patients were surgically treated at our hospital with follow up of average 20.7 months (range, 9-64 months). The anatomical locations of the lesion were on superficial peroneal nerve in seven patients including two patients having ganglion and sural nerve in four patients. Two patients were male and the average age at surgery was 41.5 years (range, 23-57 years). Six cases developed after repetitive sprain and five cases had no trauma history. Clinical results were assessed according to the criteria of Pfeiffer and Cracchiolo. Results: The methods of operation were proximal resection of the nerve lesion in nine cases and removal of ganglion only in two cases. The results were excellent in four cases, good in five cases, fair in one case and poor in one case. Ten cases (10 patients) were satisfied with the result of treatment. Conclusion: We can expect satisfactory results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.124-131
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• 2021

Background: Sciatic nerve injury due to intramuscular injection (SNIII) is still a health problem. This study aimed to determine whether there is a correlation between neuropathic pain and electrodiagnostic findings in SNIII. Methods: Patients whose clinical and electrodiagnostic findings were compatible with SNIII participated in this retrospective cohort study. Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the sural, superficial peroneal, peroneal, and tibial nerves were graded from 1 to 4. Leeds assessment of neuropathic symptoms and signs scale (LANSS) was applied to all patients. Results: Forty-eight patients were included in the study, 67% of whom had a LANSS score ≥ 12. Sural SNAP amplitude abnormalities were present in 8 (50%) out of 16 patients with a LANSS score < 12, and 28 (87.5%) out of 32 patients with a LANSS score ≥ 12, with significant differences between the groups (P = 0.011). There was a positive correlation between the LANSS score and the sural SNAP amplitude grading (P = 0.001, r = 0.476). A similar positive correlation was also found in the LANSS score and the tibial nerve CMAP amplitude grading (P = 0.004, r = 0.410). Conclusions: This study showed a positive correlation between the severity of tibial nerve CMAP/sural SNAP amplitude abnormality and LANSS score in SNIII. Neuropathic pain may be more common in SNIII patients with sural nerve SNAP amplitude abnormality.

• Annals of Clinical Neurophysiology
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• v.6 no.1
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• pp.31-34
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• 2004

Backgrounds: The pathway of the sural nerve (SN) is variable, but usually divided into medial and lateral sural branches joining the posterior tibial nerve (PTN) and the peroneal nerve (PN). The sural nerve may be affected by PN palsy. The frequency or the severity of SN involvement in peroneal palsy is not known. The purpose of the study is to investigate the frequency and the severity of the SN involvement by the peroneal nerve palsy. Methods: Total 85 patients were included with peroneal palsy. Amplitudes of distal peroneal, sural, and superficial peroneal nerves (SPN) were compared between normal and paralyzed sides. The frequency and severity of SN involvement by peroneal palsy were investigated. Results: Mean age was $48.4{\pm}17.4$ years old at the time of the test. Peroneal palsy was right side in 32, left in 38, and bilateral in 15 patients. Mean amplitudes of affected distal PN, SPN, and SN were $1.51{\pm}1.64mV$, $3.50{\pm}4.86{\mu}V$, and $10.42{\pm}6.59{\mu}V$ in right side, and $1.19{\pm}1.57mV$, $4.38{\pm}5.67{\mu}V$, and $11.06{\pm}6.87{\mu}V$ in left side, respectively. Sensory nerve action potential (SNAP) amplitude of the SN in the affected side was average $73.7{\pm}33.1%$ of normal, which was significantly lower than that in the normal side(p<0.01). The decrease of the sural SNAP amplitude was more than 15% in 39 out of 70 patients with unilateral peroneal palsy. Peroneal compound muscle action potential (CMAP) amplitude was not correlated with the amplitude of the sural SNAP. By complete peroneal palsy, SN SNAP amplitude was decreased to 4% of SNAP and $57.7{\pm}31.8%$ of that in normal side. Conclusions: PN injury without PTN involvement may induce reduction of sural SNAP amplitude. Because of the anatomic variation of SN, the electrophysiological findings are variable. It should be considered to interpret the location of the PN lesion.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.46-53
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• 2002

Purpose: We would introduce the reverse superficial sural artery flap to reconstruct soft tissue defect on lower leg, ankle, and hind-foot. Materials and Method: From October 1998 to December 2001, we reconstructed 12cases (l2patients) of soft tissue defect around the hind - foot, ankle, and distal lower extremity with the reverse sural artery flap. Results: The time for flap dissection was 28 minutes in average. The size of the flap was from $4\times3cm$ to $14\times10cm$. All flaps survived. Conclusion: The reverse superficial sural artery flap is the useful technique for the soft tissue defect in the lower leg and the foot.