Morbidity Following a Modified Sural Nerve Harvesting Procedure in Pediatric Patients
Mark Shafarenko, Medical Student1; Joseph Catapano, MD, PhD2; Emily S. Ho, BSc OT Reg (Ont), MEd2, Gregory H. Borschel, MD, FAAP, FACS2; Ronald M. Zuker, MD, FRCSC, FACS, FAAP2
1University of Toronto, Toronto, ON, Canada; 2The Hospital for Sick Children, Toronto, ON, Canada
Introduction: While sural nerve harvest is common for reconstruction of peripheral nerve injuries, only one study describes sensory deficits following this procedure in children. All patients in this study underwent bilateral sural harvest in the neonatal period for the reconstruction of obstetrical brachial plexus palsy. This study may not accurately describe the sensory deficits expected following unilateral harvest in older children. At our institution, we use a modified sural nerve harvest technique intended to decrease sensory morbidity by harvesting the tibial contribution to the sural nerve, while leaving the peroneal component intact. The purpose of this study is to provide the first analysis of sensory outcomes following sural nerve harvest in older children using a modified technique of unilateral sural nerve harvest.
Materials and Methods: A cross-sectional study was conducted on pediatric patients older than six years of age who had undergone unilateral sural nerve harvest. Patients were recruited during routine clinic visits at a minimum follow-up of six months. Sensory threshold testing was conducted on four standardized locations in the sural nerve distribution of both feet using Semmes Weinstein Monofilaments. Results were compared to the unoperated contralateral foot using Fisher's exact test. Patients also completed a sensory function and pain questionnaire.
Results: Sensory outcomes were evaluated for 14 patients. Mean age at operation was 10.7±4.2 years with a mean follow up time of 1.84±1.43 years. Sensory thresholds were restricted to the two most sensitive Semmes Weinstein monofilaments in the control group, indicating no sensory deficit. In contrast, after sural nerve harvest, 25% of all locations tested demonstrated abnormal sensation. Significant sensory deficits were found at all four locations in the sural nerve distribution (p<0.05). The questionnaire revealed that only two patients expressed concerns about foot functionality, both in relation to physical activity, and no patients reported pain in their feet.
Conclusions: Unilateral sural nerve harvest using a modified procedure in older children results in measurable sensory deficits that are larger than expected based a previous study describing outcomes in neonates. This can be attributed to an older patient age and any deficits may be more appreciable in the presence of an unoperated leg for comparison. Despite differences in objective sensory testing, there remains minimal subjective functional impairment, which is in line with previous literature. This study can be used as a valuable resource to inform patients and their families of the expected outcomes of these procedures.
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