Sural Nerve Injury How to Avoid The Sural Nerve During Laser Vein Treatment
Sural nerve injury can occur in over 1 in 10 small saphenous vein endothermal ablations.It can result in troublesome numbness in the sensory distribution of the nerve or it can cause burning pain in the heel and outside of the foot.I am going to show you how the sural nerve can be identified on an ultrasound scan and how the risk of sural nerve injury can be minimised during endothermal ablation.The sural nerve lies close to the small saphenous vein at the back of the calf and it is vulnerable to accidental injury during cannulation of.
The small saphenous vein, during the administration of perivenous tumescent local anaesthetic and during the thermal ablation procedure itself.I am very grateful to dr ted king in chicago who stimulated my interest in the anatomy of this nerve and who has done a lot of research on the zones of contact of the sural nerve and the small saphenous vein.In my opinion, the sural nerve should be visualised in transverse section and its relationship to the vein established at the proposed point of vein cannulation.Here you can see that.
The vein and nerve are very close and in contact in the distal calf here at 12cm above the malleoli.Further proximally, the vein and nerve are separated by 10mm or more.My practice is to visualise the nerve and vein in transverse section throughout the cannulation procedure, thereby minimising the risk of needle stick injuries at this stage as well as during the administration of tumescent local anaesthesia again ensuring that the local anaesthetic solution is generously administered between the nerve and vein and minimising the risk of direct needle injury to the nerve.I have never been a fan of cannulation under longitudinal.
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