Donor site morbidity after sural nerve grafting: A systematic review

Published:April 19, 2021DOI:



      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.


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


      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).


      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.


      To read this article in full you will need to make a payment


        • Menorca R.M.
        • Fussell T.S.
        • Elfar J.C.
        Nerve physiology: mechanisms of injury and recovery.
        Hand Clin. 2013; 29: 317-330
        • Boyd K.U.
        • Nimigan A.S.
        • Mackinnon S.E.
        Nerve reconstruction in the hand and upper extremity.
        Clin Plast Surg. 2011; 38: 643-660
        • Lin M.Y.
        • Manzano G.
        • Gupta R.
        Nerve allografts and conduits in peripheral nerve repair.
        Hand Clin. 2013; 29: 331-348
        • Fox I.K.
        • Mackinnon S.E.
        Adult peripheral nerve disorders: nerve entrapment, repair, transfer, and brachial plexus disorders.
        Plast Reconstr Surg. 2011; 127: 105e-118e
        • Riedl O.
        • Frey M.
        Anatomy of the sural nerve: cadaver study and literature review.
        Plast Reconstr Surg. 2013; 131: 802-810
        • Coert J.H.
        • Dellon A.L.
        Clinical implications of the surgical anatomy of the sural nerve.
        Plast Reconstr Surg. 1994; 94: 850-855
        • Aszmann O.C.
        • Muse V.
        • Dellon A.L.
        Evidence in support of collateral sprouting after sensory nerve resection.
        Ann Plast Surg. 1996; 37: 520-525
        • Ehretsman R.L.
        • Novak C.B.
        • Mackinnon S.E.
        Subjective recovery of nerve graft donor site.
        Ann Plast Surg. 1999; 43: 606-612
        • Healy C.
        • LeQuesne P.M.
        • Lynn B.
        Collateral sprouting of cutaneous nerves in man.
        Brain. 1996; 119: 2063-2072
        • Miloro M.
        • Stoner J.A.
        Subjective outcomes following sural nerve harvest.
        J Oral Maxillofac Surg. 2005; 63: 1150-1154
        • Oberle J.
        • Richter H.P.
        [Painful paresthesia after removal of the sural nerve for autologous nerve transplantation].
        Zentralbl Neurochir. 1998; 59: 1-3
        • Staniforth P.
        • Fisher T.R.
        The effects of sural nerve excision in autogenous nerve grafting.
        Hand. 1978; 10: 187-190
        • Trumble T.E.
        • Vanderhooft E.
        • Khan U.
        Sural nerve grafting for lower extremity nerve injuries.
        J Orthop Trauma. 1995; 9: 158-163
        • Yavuzer R.
        • Yavuzer G.
        • Ergin S.
        • Latifoglu O.
        Gait analysis: a new perspective on sural nerve graft donor site morbidity assessment.
        Ann Plast Surg. 2002; 48: 449-450
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Ng S.S.
        • Kwan M.K.
        • Ahmad T.S.
        Quantitative and qualitative evaluation of sural nerve graft donor site.
        Med J Malaysia. 2006; 61 (Suppl): 13-17
        • Martins R.S.
        • Barbosa R.A.
        • Siqueira M.G.
        • et al.
        Morbidity following sural nerve harvesting: a prospective study.
        Clin Neurol Neurosurg. 2012; 114: 1149-1152
        • Lapid O.
        • Ho E.S.
        • Goia C.
        • Clarke H.M.
        Evaluation of the sensory deficit after sural nerve harvesting in pediatric patients.
        Plast Reconstr Surg. 2007; 119: 670-674
        • Hallgren A.
        • Bjorkman A.
        • Chemnitz A.
        • Dahlin L.B.
        Subjective outcome related to donor site morbidity after sural nerve graft harvesting: a survey in 41 patients.
        BMC Surg. 2013; 13: 39
        • FF I.J.
        • Nicolai J.P.
        • Meek M.F
        Sural nerve donor-site morbidity: thirty-four years of follow-up.
        Ann Plast Surg. 2006; 57: 391-395
        • Catapano J.
        • Shafarenko M.
        • Ho E.S.
        • Zuker R.M.
        • Borschel G.H.
        Sensory and functional morbidity following sural nerve harvest in paediatric patients.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1711-1716
        • Butler D.P.
        • Johal K.S.
        • Wicks C.E.
        • Grobbelaar A.O.
        Objective sensory and functional outcomes at the donor site following endoscopic-assisted sural nerve harvest.
        J Plast Reconstr Aesthet Surg. 2017; 70: 659-665
        • Novak C.B.
        • Mackinnon S.E.
        Evaluation of cold sensitivity, pain, and quality of life after upper extremity nerve injury.
        Hand. 2016; 11: 173-176
        • Wojtkiewicz D.M.
        • Saunders J.
        • Domeshek L.
        • Novak C.B.
        • Kaskutas V.
        • Mackinnon S.E.
        Social impact of peripheral nerve injuries.
        Hand. 2015; 10: 161-167
        • Watson J.
        • Gonzalez M.
        • Romero A.
        • Kerns J.
        Neuromas of the hand and upper extremity.
        J Hand Surg Am. 2010; 35: 499-510
        • Novak C.B.
        Cold intolerance after nerve injury.
        J. Hand Ther. 2018; 31: 195-200