#Saphenous Nerve Release

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Saphenous Nerve Release
Extended Edition (150401.150403)

Courtesy: Authors: Susan E. Mackinnon, Andrew Yee Affiliation: Washington University School of Medicine Division of Plastic Reconstructive Surgery, Department of Surgery, Saint Louis, MO Peripheral Nerve Surgery: http://nervesurgery.wustl.edu

Entrapment of the saphenous nerve is probably under-recognized and presents with numbness/pain in the infrapatellar region and the medial aspect of the lower leg. The vastoadductor intermuscular septum is responsible for entrapment symptoms as it forms the anterior fascia of the adductor canal, deep to the sartorius muscle. The femoral vessels and saphenous nerve have a course within this canal and the nerve may anteriorly pierce through the intermuscular septum. Decompression of the saphenous nerve involves the release of the vastoadductor intermuscular septum. In this case, the patient presented with severe pain in the lower extremity and diagnosed with complex regional pain syndrome. Her neuropathic pain began seven-years-ago following a revision knee operation for knee stiffness. The patient described the regions of neuropathic pain on the lateral aspect of the foot, lateral aspect of the lower leg, and medial aspect of the thigh. Provocative tests, specifically the scratch collapse test with ethyl chloride, identified provocation in the following order: superficial peroneal nerve, common peroneal nerve, and saphenous nerve. Release of the superficial peroneal nerve, common peroneal nerve, and saphenous nerve were elected. This video details the specifics for the saphenous nerve release.

Tables of Contents (Extended)
00:35 Incision and Superficial Dissection
01:40 Identifying the Layer of Superficial Fascia
02:28 Dissecting through the Superficial Fascia and Protecting Cutaneous Nerves
03:55 Exposing the Anterior and Posterior Border of the Sartorius Muscle
05:45 Dissection through the Posterior Border of the Sartorius Muscle
07:27 Identifying the Superficial Fascia of the Adductor Canal
08:54 Identifying the Femoral Vessels and Saphenous Nerve deep to the Fascia
09:58 Proximal Exposure of the Saphenous Nerve
10:35 Release of the Saphenous Nerve
12:16 Exposing the Vastoadductor Intermuscular Septum
14:00 Dividing the Vastoadductor Intermuscular Septum
14:30 Identifying and Releasing the Distal End of the Intermuscular Septum
16:40 Dissection through the Anterior Border of the Sartorius Muscle
17:34 Identifying and Releasing a Distal Compressive Septum
18:36 Distal Exposure of the Two Branches of the Saphenous Nerve

Narration: Susan E. Mackinnon
Videography: Andrew Yee

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