Sihler's staining of the cutaneous nerves of the leg and its implications for sensory reconstruction.
Sihler's stain
cutaneous nerves distribution
leg
sensory reconstruction
Journal
Clinical anatomy (New York, N.Y.)
ISSN: 1098-2353
Titre abrégé: Clin Anat
Pays: United States
ID NLM: 8809128
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
06
04
2020
received:
14
11
2019
accepted:
18
04
2020
pubmed:
23
4
2020
medline:
21
10
2021
entrez:
23
4
2020
Statut:
ppublish
Résumé
This study aimed to reveal the entire cutaneous nerve distribution pattern of the leg and provide a morphological basis for sensory reconstruction during skin flap transplantation. Twelve adult cadavers were fixed with formalin, and the whole leg skin with subcutaneous fat was removed close to the muscle surface. The cutaneous nerves were visualized using modified Sihler's staining to reveal the distribution and innervation density of the cutaneous nerves. The saphenous nerve innervated the anterior part, 82.2% of the upper-middle region of the lateral part of the anterolateral leg, and the upper 63.4% of the medial posterior leg. The superficial peroneal nerve innervated 90.1% of the lateral lower one-third of the anterolateral leg. The medial sural cutaneous nerve covered 26.4% of the posterior leg. The lateral sural cutaneous nerve covered 42.3% (approximately 28.6% overlap with the saphenous nerve) of the upper-middle region of the anterolateral and posterolateral leg. The number of branches differed between certain cutaneous nerves in the leg. Communications were observed between the arborizations of the four cutaneous nerves mentioned above. The highest density of primary and secondary nerve branches was observed in the upper one-third of the lateral posterior leg. The upper one-third of the posteromedial leg contained the highest density of intracutaneous nerve branches and highest number of total nerve branches. These results may be used to map sensory regions when designing leg skin flaps for reconstruction surgery to obtain improved sensory recovery.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
565-573Subventions
Organisme : National Natural Science Foundation of China
ID : 31660294
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Boyd, J. B., Caton, A. M., Mulholland, R. S., & Granzow, J. W. (2013). The sensate fibular osteoneurocutaneous flap in oromandibular reconstruction: Clinical outcomes in 31 cases. Journal of Plastic, Reconstructive and Aesthetic Surgery, 66, 1695-1701.
Chang, Y. M., Rodriguez, E. D., Chu, Y. M., Tsai, C. Y., & Wei, F. C. (2012). Inferior alveolar nerve reconstruction with interpositional sural nerve graft: A sensible addition to one-stage mandibular reconstruction. Journal of Plastic, Reconstructive and Aesthetic Surgery, 65, 757-762.
Cho, T. H., Kwon, H. J., Choi, Y. J., Choi, O. J., Won, S. Y., Yang, H. M., & Yang, H. M. (2019). Intramuscular innervation of the subscapularis muscle and its clinical implication for the BoNT injection: An anatomical study using the modified Sihler's staining. Clinical Anatomy, 32, 110-116.
Cho, Y. J., Lee, J. H., & Chung, D. W. (2017). Pedicled chimeric gastrocnemius-medial sural artery adipofascial flap for reconstruction of anterolateral defects of the knee. Microsurgery, 37, 206-211.
Collongues, N., Samama, B., Schmidt-Mutter, C., Chamard-Witkowski, L., Debouverie, M., Chanson, J. B., … Boehm, N. (2018). Quantitative and qualitative normative dataset for intraepidermal nerve fibers using skin biopsy. PLoS One, 13, e0191614.
Daya, M. (2008). Peroneal artery perforator chimeric flap: Changing the perspective in free fibula flap use in complex oromandibular reconstruction. Journal of Reconstructive Microsurgery, 24, 413-418.
Frank, H. (2014). Netter atlas of human anatomy (pp. 566-570). Philadelphia, PA: Saunders Elsevier.
Gascoigne, A. C., Ian Taylor, G., Corlett, R. J., Briggs, C., & Ashton, M. W. (2017). The relationship of superficial cutaneous nerves and interperforator connections in the leg: A cadaveric anatomical study. Plastic and Reconstructive Surgery, 139, 994e-1002e.
Grinsell, D., & Keating, C. P. (2014). Peripheral nerve reconstruction after injury: A review of clinical and experimental therapies. BioMed Research International, 2014, 698256.
Ide, C., Tohyama, K., Yokota, R., Nitatori, T., & Onodera, S. (1983). Schwann cell basal lamina and nerve regeneration. Brain Research, 288, 61-75.
Kim, K. H., Yoo, J. Y., & You, B. C. (2014). Ultrasonographic evaluation of sural nerve for nerve conduction study. Annals of Rehabilitation Medicine, 38, 46-51.
Korompilias, A., Gkiatas, I., Korompilia, M., Kosmas, D., & Kostas-Agnantis, I. (2019). Reverse sural artery flap: A reliable alternative for foot and ankle soft tissue reconstruction. European Journal of Orthopaedic Surgery and Traumatology, 29, 367-372.
Kwon, H. J., Kim, H. S., Kim, O. J., Kang, H. J., Won, J. Y., Yang, H. M., … Choi, Y. J. (2018). Anatomical analysis of the distribution patterns of occipital cutaneous nerves and the clinical implications for pain management. Journal of Pain Research, 11, 2023-2031.
Lauria, G., Dacci, P., Lombardi, R., Cazzato, D., Porretta-Serapiglia, C., Taiana, M., … Devigili, G. (2015). Side and time variability of intraepidermal nerve fiber density. Neurology, 84, 2368-2371.
Li, H., Zhu, W., Wu, S., Wei, Z. R., & Yang, S. B. (2019). Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction. PLoS One, 14, e0223916.
Mok, W. L., Por, Y. C., & Tan, B. K. (2014). Distally based sural artery adipofascial flap based on a single sural nerve branch: Anatomy and clinical applications. Archives of Plastic Surgery, 41, 709-715.
Netscher, D., Armenta, A. H., Meade, R. A., & Alford, E. L. (2000). Sensory recovery of innervated and non-innervated radial forearm free flaps: Functional implications. Journal of Reconstructive Microsurgery, 16, 179-185.
Nuri, T., Ueda, K., Maeda, S., & Otsuki, Y. (2012). Anatomical study of medial and lateral sural cutaneous nerve: Implications for innervated distally-based superficial sural artery flap. Journal of Plastic Surgery and Hand Surgery, 46, 8-12.
Popieluszko, P., Mizia, E., Henry, B. M., PĘkala, P. A., Sanna, B., Roy, J., … Tomaszewski, K. A. (2018). The surgical anatomy of the sural nerve: An ultrasound study. Clinical Anatomy, 31, 450-455.
Ramakrishnan, P. K., Henry, B. M., Vikse, J., Roy, J., Saganiak, K., Mizia, E., & Tomaszewski, K. A. (2015). Anatomical variations of the formation and course of the sural nerve: A systematic review and meta-analysis. Annals of Anatomy, 202, 36-44.
Tan, O., Aydin, O. E., Demir, R., Barin, E. Z., Cinal, H., & Algan, S. (2015). Neurotized sural flap: An alternative in sensory reconstruction of the foot and ankle defects. Microsurgery, 35, 183-189.
Tang, S., Zhang, X. M., & Yang, S. (2018). Localization of center of intramuscular nerve dense regions in adult anterior brachial muscles: A guide for botulinum toxin A injection to treat muscle spasticity. American Journal of Translational Research, 10, 1220-1228.
Wang, C. Y., Chai, Y. M., Wen, G., Cai, P. H., Sun, L. Y., Mei, G. H., … Liu, S. H. (2011). The free peroneal perforator-based sural neurofasciocutaneous flap: A novel tool for reconstruction of large soft-tissue defects in the upper limb. Plastic and Reconstructive Surgery, 127, 293-302.
Wilmot, V. V., & Evans, D. J. (2013). Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein. Clinical Anatomy, 26, 531-536.
Yan, Y., Fu, X., Xie, X., Ji, S., Luo, H., Yang, F., … Xie, P. (2019). Hip adductor intramuscular nerve distribution pattern of children: A guide for BTX-A treatment to muscle spasticity in cerebral palsy. Frontiers in Neurology, 14, 616.
Yang, S., Hu, S., Li, B., & Li, X. (2017). Localization of nerve entry point and intramuscular nerve-dense regions as targets to block brachioradialis muscle spasticity. International Journal of Clinical and Experimental Medicine, 10, 11912-11920.
Zhang, G. L., Meng, H., Huang, J. H., Hong, X. F., Zhang, H. S., Liu, X. T., … Liu, W. Y. (2015). Reconstruction of digital skin defects with the free wrist crease flap. Journal of Reconstructive Microsurgery, 31, 471-476.
Zheng, H., Liu, J., Dai, X., & Schilling, A. F. (2016). The distally based sural flap for the reconstruction of ankle and foot defects in pediatric patients. Annals of Plastic Surgery, 77, 97-101.