Endoscopy-assisted sural nerve harvest in infants.

A minimally invasive method of endoscopy-assisted sural nerve (SN) harvest in infants with obstetric brachial plexus lesions requiring nerve grafting procedures was applied to reduce the skin incision size and scarring at the donor site. Endoscopic visualization was achieved using a flexible and steerable Neuroview neuronavigational endoscope (Promedics, NL) 2.3 mm in diameter and 12 or 18 cm long in a peelaway sheath (700-9F) attached to a video camera. Through three 1.5-cm skin incisions the SN could be dissected free using a 2.5-mm-diameter nerve stripper, pituitary curette or pituitary scissors under endoscopic vision from the opposite direction. To prevent any central nociceptive pain behavior the sural nerve was blocked by lidocaine, and sectioned first proximally in the popliteal fossa then distally at the lateral malleolus.