Surgical anatomy of the saphenous nerve

Victor Dayan, Leandro Cura, Santiago Cubas, Guillermo Carriquiry
Annals of Thoracic Surgery 2008, 85 (3): 896-900

BACKGROUND: During harvest of the saphenous vein (SV), the most important relationship to take into account is the saphenous nerve (SN) to avoid pain and paresthesias after surgery.

METHODS: We harvested the SV and SN in 20 cadaveric lower limbs. Relationships between both structures were recorded using a millimetric ruler, and distances were measured from the medial malleolus at the ankle.

RESULTS: The SV was superficial to the leg fascia 32 cm above the malleolus in 95% of the legs. During its course in the leg, 40% of SNs are posterior to the SV; 40% are anterior and then posterior to the SV; and 10% are posterior and then hidden by the SV. The SN crosses the SV in 55% of the legs. Three constant branches of the SN were identified: middle-posterior, middle-anterior, and inferior-anterior. The SN ends by splitting 5.9 cm above the malleolus. A vulnerable region occurs in the lowest 13.2 cm, where the SN adheres to the SV. At this level the SN gives off the inferior-anterior branch that crosses the SV in 66% of the legs. Between 21.6 cm and 28.8 cm the SN crosses deep to the SV.

CONCLUSIONS: During harvest of the SV, the most vulnerable area is the inferior third of the leg because of venonervous adhesion.

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