title: Microsurgical repair of the sural nerve after nerve biopsy to avoid associated sensory morbidity: a preliminary report.
abstract: OBJECTIVE
  The purpose of this article is to report our preliminary results regarding microsurgical repair of the sural nerve after nerve biopsy, in an attempt to reduce the well-described sensory morbidity and neuroma formation.
  
  
  METHODS
  Three patients with a suspected diagnosis of peripheral neuropathy underwent sural nerve biopsies to establish definitive diagnoses. A 10-mm segment of the sural nerve was resected with local anesthesia. After harvesting of the specimen, the proximal and distal nerve stumps were carefully mobilized and united with epineural suture techniques, under a surgical microscope. Sensory evaluations (assessing the presence of hypesthesia/dysesthesia or pain) of the lateral aspect of the foot, in regions designated Areas 1, 2, and 3, were performed before and 6 and 12 months after the biopsies. A visual analog scale was used for pain estimation.
  
  
  RESULTS
  The biopsy material was sufficient for histopathological examinations in all cases, leading to conclusive diagnoses (vasculitis in two cases and amyloidosis in one case). The early post-biopsy hypesthesia, which was present for 4 to 8 weeks, improved to preoperative levels as early as 6 months after the nerve repair. Sensory evaluations performed at 6- and 12-month follow-up times demonstrated that none of the patients complained of pain at the biopsy site or distally in the area innervated by the sural nerve. Ultrasonography performed at the 12-month follow-up examination revealed normal sural nerve morphological features, with no neuroma formation, comparable to findings for the contralateral site.
  
  
  CONCLUSIONS
  Microsurgical repair of the sural nerve after biopsy can eliminate or reduce sensory disturbances such as paraesthesia, hypesthesia, and dysesthesia distal to the biopsy site, in the distribution of the sensory innervation of the sural nerve, and can prevent painful neuroma formation. To our knowledge, this article is the first in the literature to report on microsurgical repair of the sural nerve after nerve biopsy. Decreased side effects suggest that this technique can become a standard procedure after sural nerve biopsy, which is commonly required to establish the diagnosis of various diseases, such as peripheral nerve pathological conditions, vasculitis, and amyloidosis. More cases should be analyzed, however, to explore the usefulness of the technique and the reliability of sural nerve biopsy samples in attempts to obtain conclusive diagnoses.
authors.affiliation: Department of Plastic and Reconstructive Surgery and Ludwig Boltzmann Institute for Quality Control in Plastic Surgery, Leopold Franzens University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schoeller
authors.forename: Georg M
authors.initials: GM
authors.lastname: Huemer
authors.forename: Maziar
authors.initials: M
authors.lastname: Shafighi
authors.forename: Raffi
authors.initials: R
authors.lastname: Gurunluoglu
authors.forename: Gottfried
authors.initials: G
authors.lastname: Wechselberger
authors.forename: Hildegunde
authors.initials: H
authors.lastname: Piza-Katzer
mesh_terms: D000368:Aged; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000294:innervation; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis / Q000601:surgery*; D010523:Peripheral Nervous System Diseases / Q000473:pathology*; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012678:Sensation Disorders / Q000175:diagnosis / Q000601:surgery*; D013497:Sural Nerve / Q000473:pathology* / Q000601:surgery*; D013536:Suture Techniques