Sural nerve harvest: anatomy and technique.

A minimally-invasive technique of sural nerve harvesting using an initial blunt tip harvesting device, combined with a recessed sharp cutting mechanism for final severance of the nerve, has been developed. Important surgical landmarks have been established, based on a review of the anatomy of the sural nerve. Harvesting is begun through a small incision at the level of the lateral malleolus, thereby identifying the nerve and inserting the nerve-harvesting device. An additional small incision, if needed, is placed at the junction of the middle and distal thirds of the lower leg, a landmark at which an anastomosis between the medial and lateral sural cutaneous nerves is seen in at least 74 percent of patients. When this anastomosis is palpated, the lateral sural cutaneous nerve is visualized and divided, and the dissection of the medial sural cutaneous nerve proceeds in a proximal direction. At the distal end below the popliteal fossa, the cutting mechanism is safely deployed, transecting the nerve. This combination of a limited incision approach with the blunt harvester and sharp, protected division provides 30 to 35 cm of sural nerve graft in the great majority of patients, while reducing the complications often associated with open techniques and minimally-invasive techniques that rely on sharp or blunt instrumentation.