Donor site morbidity after sural nerve grafting: A systematic review

Background: Understanding the morbidity of sural nerve harvest is important when counselling patients regarding nerve grafts. Existing data consist of small studies with varying degrees of follow-up and a wide range of reported donor site outcomes. The objective of this study was to systematically review the literature and pool the current data for postoperative outcomes after sural nerve graft harvest.

Methods: A systematic review of literature was conducted to identify studies that examined donor site outcomes of sural nerve graft harvests.

Results: Five-hundred and fourteen studies were identified through a literature search, and nine studies met inclusion criteria. There were 240 patients who underwent sural nerve grafts. The most common methods for sensory evaluation were patient survey (44.4%) and Semmes-Weinstein evaluation (33.3%). Five studies reported surface areas of sensory loss, and this generally decreased over time after sural nerve grafting. Overall, 87.2% of patients (n = 190) reported sensory loss, 25.6% (n = 42) of patients reported pain, 22.2% (n = 28) of patients reported cold sensitivity, and 10% (n = 20) of patients reported functional impairment at follow-up. When the proximal sural nerve was spared during harvest, the extent of sensory loss and pain were less than harvest at the popliteal fossa (87.4% vs 95.7%, p = 0.0407 and 9.1% vs 35.5%, p = 0.0004, respectively).

Conclusions: In this study, we present the extent of sensory loss and rates of pain, cold sensitivity, and functional impairment after sural nerve harvest. These data should be discussed prior to surgery in order for patients and surgeons to make an informed decision.