{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:23:09Z","timestamp":1792790589658,"version":"4.5.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The object of this study was to highlight the challenge of insufficient donor graft material in peripheral nerve surgery, with a specific focus on sciatic nerve transection requiring autologous sural nerve graft.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed an anatomical analysis of cadaveric sciatic and sural nerve tissue. To complement this they also present 3 illustrative clinical cases of sciatic nerve injuries with segmental defects. In the anatomical study, the cross-sectional area (CSA), circumference, diameter, percentage of neural tissue, fat content of the sural nerves, as well as the number of fascicles, were measured from cadaveric samples. The percentage of neural tissue was defined as the CSA of fascicles lined by perineurium relative to the CSA of the sural nerve surrounded by epineurium.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Sural nerve samples were obtained from 8 cadaveric specimens. Mean values and standard deviations from sural nerve measurements were as follows: CSA 2.84 \u00b1 0.91 mm<jats:sup>2<\/jats:sup>, circumference 6.67 \u00b1 1.60 mm, diameter 2.36 \u00b1 0.43 mm, fat content 0.83 \u00b1 0.91 mm<jats:sup>2<\/jats:sup>, and number of fascicles 9.88 \u00b1 3.68. The percentage of neural tissue seen on sural nerve cross-section was 33.17% \u00b1 4.96%. One sciatic nerve was also evaluated. It had a CSA of 37.50 mm<jats:sup>2<\/jats:sup>, with 56% of the CSA representing nerve material. The estimated length of sciatic nerve that could be repaired with a bilateral sural nerve harvest (85 cm) varied from as little as 2.5 cm to as much as 8 cm.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Multiple methods have been used in the past to repair sciatic nerve injury but most commonly, when a considerable gap is present, autologous nerve grafting is required, with sural nerve being the foremost source. As evidenced by the anatomical data reported in this study, a considerable degree of variability exists in the diameter of sural nerve harvests. Conversely, the percentage of neural tissue is relatively consistent across specimens. The authors recommend that the peripheral nerve surgeon take these points into consideration during nerve grafting as insufficient graft material may preclude successful recovery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.2.jns131667","type":"journal-article","created":{"date-parts":[[2014,4,11]],"date-time":"2014-04-11T14:00:41Z","timestamp":1397224841000},"page":"210-218","source":"Crossref","is-referenced-by-count":42,"title":["Challenges in sciatic nerve repair: anatomical considerations"],"prefix":"10.3171","volume":"121","author":[{"given":"S. Shelby","family":"Burks","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Levi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan D.","family":"Levi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns131667","series-title":"Reg Anesth Pain Med","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1097\/AAP.0b013e31825145f3","article-title":"Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis","volume":"37","author":"Andersen","year":"2012"},{"key":"b2-jns131667","series-title":"Acta Orthop Traumatol Turc","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3944\/AOTT.2010.2172","article-title":"The results of surgical repair of sciatic nerve injuries","volume":"44","author":"Aydin","year":"2010"},{"key":"b3-jns131667","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1002\/micr.20127","article-title":"Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair","volume":"25","author":"Battiston","year":"2005"},{"key":"b4-jns131667","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1179\/016164104225013798","article-title":"Peripheral nerve regeneration through guidance tubes","volume":"26","author":"Belkas","year":"2004"},{"key":"b5-jns131667","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"720","DOI":"10.3171\/2013.4.JNS121189","article-title":"Transplantation of Schwann cells in a collagen tube for the repair of large, segmental peripheral nerve defects in rats. Laboratory investigation","volume":"119","author":"Berrocal","year":"2013"},{"key":"b6-jns131667","series-title":"J Reconstr Microsurg","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1055\/s-2007-1000090","article-title":"Peripheral nerve revascularization: histomorphometric study of small- and large-caliber grafts","volume":"15","author":"Best","year":"1999"},{"key":"b7-jns131667","series-title":"Microsurgery","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/micr.20975","article-title":"Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions","volume":"32","author":"Brooks","year":"2012"},{"key":"b8-jns131667","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1002\/mus.23718","article-title":"Nerve cross-sectional area in extremes of age","volume":"47","author":"Cartwright","year":"2013"},{"key":"b9-jns131667","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1002\/mus.21009","article-title":"Cross-sectional area reference values for nerve ultrasonography","volume":"37","author":"Cartwright","year":"2008"},{"key":"b10-jns131667","series-title":"Ann Vasc Surg","first-page":"729.e11","article-title":"Fibular nerve injury after small saphenous vein surgery","volume":"26","author":"de Alvarenga Yoshida","year":"2012"},{"issue":"6 Suppl","key":"b11-jns131667","series-title":"Neurosurgery","first-page":"218","article-title":"Proximal motor branches from the tibial nerve as direct donors to restore function of the deep fibular nerve for treatment of high sciatic nerve injuries: a cadaveric feasibility study","volume":"65","author":"Flores","year":"2009"},{"key":"b12-jns131667","series-title":"Ann Plast Surg","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/00000637-199507000-00006","article-title":"Serratus anterior intercostal nerve graft: a new vascularized nerve graft","volume":"35","author":"Gailliot","year":"1995"},{"key":"b13-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1097\/01.prs.0000299286.67932.88","article-title":"Therapeutic results of sciatic nerve repair in Iran-Iraq war casualties","volume":"121","author":"Gousheh","year":"2008"},{"key":"b14-jns131667","series-title":"J Rehabil Res Dev","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1682\/JRRD.2010.10.0201","article-title":"Human distal sciatic nerve fascicular anatomy: implications for ankle control using nerve-cuff electrodes","volume":"49","author":"Gustafson","year":"2012"},{"key":"b15-jns131667","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1053\/jhsu.2002.31154","article-title":"Assessment of nerve graft donor sites used for reconstruction of traumatic digital nerve defects","volume":"27","author":"Higgins","year":"2002"},{"key":"b16-jns131667","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1002\/mus.23625","article-title":"Nerve ultrasound in diabetic polyneuropathy: correlation with clinical characteristics and electrodiagnostic testing","volume":"47","author":"Hobson-Webb","year":"2013"},{"key":"b17-jns131667","series-title":"Hand (NY)","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s11552-009-9195-6","article-title":"Early clinical outcomes with the use of decellularized nerve allograft for repair of sensory defects within the hand","volume":"4","author":"Karabekmez","year":"2009"},{"key":"b18-jns131667","series-title":"Injury","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1016\/j.injury.2010.12.030","article-title":"FDA approved guidance conduits and wraps for peripheral nerve injury: a review of materials and efficacy","volume":"43","author":"Kehoe","year":"2012"},{"key":"b19-jns131667","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.jvs.2011.11.127","article-title":"The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation","volume":"56","author":"Kerver","year":"2012"},{"key":"b20-jns131667","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3171\/jns.2004.101.1.0008","article-title":"Management and outcomes in 353 surgically treated sciatic nerve lesions","volume":"101","author":"Kim","year":"2004"},{"key":"b21-jns131667","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3171\/jns.1998.89.1.0013","article-title":"Management and results of sciatic nerve injuries: a 24-year experience","volume":"89","author":"Kline","year":"1998"},{"key":"b22-jns131667","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E1321","DOI":"10.1227\/NEU.0b013e31822a9fd2","article-title":"Neurological recovery across a 12-cm-long ulnar nerve gap repaired 3.25 years post trauma: case report","volume":"69","author":"Kuffler","year":"2011"},{"key":"b23-jns131667","series-title":"Br J Anaesth","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1093\/bja\/aep368","article-title":"Minimal local anaesthetic volumes for sciatic nerve block: evaluation of ED 99 in volunteers","volume":"104","author":"Latzke","year":"2010"},{"key":"b24-jns131667","series-title":"Exp Neurol","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1006\/exnr.1994.1183","article-title":"Studies of myelin formation after transplantation of human Schwann cells into the severe combined immunodeficient mouse","volume":"130","author":"Levi","year":"1994"},{"issue":"2 Suppl","key":"b25-jns131667","series-title":"J Neurosurg","first-page":"197","article-title":"Peripheral nerve grafts promoting central nervous system regeneration after spinal cord injury in the primate","volume":"96","author":"Levi","year":"2002"},{"key":"b26-jns131667","series-title":"PLoS ONE","doi-asserted-by":"publisher","first-page":"e32730","DOI":"10.1371\/journal.pone.0032730","article-title":"Preliminary evaluation of the sural nerve using 22-MHz ultrasound: a new approach for evaluation of diabetic cutaneous neuropathy","volume":"7","author":"Liu","year":"2012"},{"key":"b27-jns131667","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/S0363-5023(05)80188-1","article-title":"Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized, clinical study","volume":"22","author":"Lundborg","year":"1997"},{"key":"b28-jns131667","series-title":"J Hand Surg Br","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.jhsb.2003.09.018","article-title":"Tubular repair of the median or ulnar nerve in the human forearm: a 5-year follow-up","volume":"29","author":"Lundborg","year":"2004"},{"key":"b29-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1097\/00006534-199003000-00015","article-title":"Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube","volume":"85","author":"Mackinnon","year":"1990"},{"key":"b30-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1419","DOI":"10.1097\/00006534-200105000-00016","article-title":"Clinical outcome following nerve allograft transplantation","volume":"107","author":"Mackinnon","year":"2001"},{"key":"b31-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1097\/00006534-199901000-00016","article-title":"Endoscopic technique for harvesting the intercostal nerve as a nerve graft: a feasibility preliminary study in cadavers","volume":"103","author":"Mohammad","year":"1999"},{"key":"b32-jns131667","series-title":"Hand (NY)","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1007\/s11552-008-9158-3","article-title":"Limitations of conduits in peripheral nerve repairs","volume":"4","author":"Moore","year":"2009"},{"key":"b33-jns131667","series-title":"Clinically Oriented Anatomy","first-page":"555","author":"Moore","year":"2006"},{"issue":"4 Suppl","key":"b34-jns131667","series-title":"Neurosurgery","first-page":"A18","article-title":"Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 806 Louisiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions","volume":"65","author":"Murovic","year":"2009"},{"key":"b35-jns131667","series-title":"Acta Neuropathol","first-page":"217","article-title":"The normal sural nerve in man. II. Changes in the axons and Schwann cells due to ageing","volume":"13","author":"Ochoa","year":"1969"},{"key":"b36-jns131667","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1136\/jnnp.31.5.464","article-title":"The fibre size and content of the radial and sural nerves","volume":"31","author":"O'Sullivan","year":"1968"},{"key":"b37-jns131667","series-title":"J Plast Reconstr Aesthet Surg","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1016\/j.bjps.2009.12.010","article-title":"Modern surgical management of peripheral nerve gap","volume":"63","author":"Pabari","year":"2010"},{"key":"b38-jns131667","series-title":"Exp Neurol","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.expneurol.2009.03.031","article-title":"Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy","volume":"223","author":"Ray","year":"2010"},{"key":"b39-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1097\/PRS.0b013e3182818cd4","article-title":"Anatomy of the sural nerve: cadaver study and literature review","volume":"131","author":"Riedl","year":"2013"},{"key":"b40-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1097\/PRS.0b013e318180ed75","article-title":"Sural nerve harvesting beyond the popliteal region allows a significant gain of donor nerve graft length","volume":"122","author":"Riedl","year":"2008"},{"key":"b41-jns131667","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3171\/jns.2005.103.4.0622","article-title":"Missile-induced complete lesions of the tibial nerve and tibial division of the sciatic nerve: results of 119 repairs","volume":"103","author":"Roganovi\u0107","year":"2005"},{"key":"b42-jns131667","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1136\/jnnp.2010.211334","article-title":"MRI shows increased sciatic nerve cross sectional area in inherited and inflammatory neuropathies","volume":"82","author":"Sinclair","year":"2011"},{"key":"b43-jns131667","series-title":"Nerves and Nerve Injuries","first-page":"621","author":"Sunderland","year":"1978"},{"key":"b44-jns131667","series-title":"Muscle Nerve","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1002\/mus.23417","article-title":"Reliability of side-to-side ultrasound cross-sectional area measurements of lower extremity nerves in healthy subjects","volume":"46","author":"Tagliafico","year":"2012"},{"key":"b45-jns131667","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1097\/00006534-200010000-00013","article-title":"A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans","volume":"106","author":"Weber","year":"2000"},{"key":"b46-jns131667","series-title":"J Hand Surg Am","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/0363-5023(94)90012-4","article-title":"Use of intercostal nerves as nerve grafts in hand reconstruction with rectus abdominis flaps","volume":"19","author":"Yim","year":"1994"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/1\/article-p210.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/1\/article-p210.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/1\/article-p210.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T01:00:45Z","timestamp":1658710845000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/1\/article-p210.xml"}},"subtitle":["Laboratory investigation"],"short-title":[],"issued":{"date-parts":[[2014,7]]},"references-count":46,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2014.2.jns131667","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7]]}}}