title: The sentinel vein: an anatomical guide to localisation of the dorsomedial cutaneous nerve in hallux surgery.
abstract: Damage to the dorsomedial branch of the medial dorsal cutaneous nerve is not uncommon in surgery of the hallux. The resultant morbidity can be disabling. In the light of the senior author's operative observation of a sentinel vein, we undertook a cadaver study to investigate the anatomical relationships of the dorsomedial branch of the medial dorsal cutaneous nerve. This established that in 14 of 16 cadaver great toes exposed via a modified medial incision, there is an easily identified vein which runs transversely superficial and proximal to the nerve. In a prospective clinical study of 171 operations on the great toe using this approach, we confirmed this anatomical relationship in 142 procedures (83%), with no complaint of numbness or pain in the scar at follow-up. We attribute this to careful identification of the 'sentinel' vein and the subjacent sensory nerve, which had been successfully protected from damage. We recommend this technique when operating on the great toe.
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, UK.
authors.forename: N
authors.initials: N
authors.lastname: Makwana
authors.forename: M
authors.initials: M
authors.lastname: Hossain
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: A
authors.initials: A
authors.lastname: Mbako
mesh_terms: D006214:Hallux / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D006215:Hallux Valgus / Q000601:surgery; D006801:Humans; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000033:anatomy & histology; D011446:Prospective Studies; D012867:Skin / Q000098:blood supply / Q000294:innervation*; D014680:Veins / Q000033:anatomy & histology