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Friday, January 11, 2008 - 4:34 PM

Saphenous Nerve Neuropathy: Treatment Options and Outcomes

Larson E, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, USA and Ducic I, Plastic Surgery, Georgetown University Hospital, 1st Floor PHC Building, 3800 Reservoir Road NW, Washington, DC, USA.

Purpose: There is not much reported about leg pain and paresthesia related to saphenous nerve neuropathy. Extending from the groin area to the dorso-medial foot, the saphenous nerve is exposed to a number of possible danger zones. It can be compressed, due to trauma or other conditions, at the adductor canal causing mid-thigh pain and distal paresthesia, or can be damaged as a result of previous surgeries (vascular surgery saphenous vein harvest, orthopaedic knee surgery or foot and ankle surgery). Despite the number of opportunities to cause saphenous nerve neuropathy, its involvement remains under diagnosed primarily due to lack of recognition of the problem by other specialties. We reviewed 20 consecutive patients and present their outcomes.

Methods: Common to all 20 patients is that their pain was present for at least 9 months (9m-2.7y) and that all conservative pain modalities failed to provide relief. Three patients had nerve compression at the adductor canal (one idiopathic, two following blunt trauma). Two patients had nerve exposed in open wound (sickle cell), five patients had pain due to orthopaedic procedures in the lower extremity and foot, while ten had pain following knee surgery. All patients had moderate to major quality of life issues due to the pain. Patients who had nerve compression at the adductor canal were decompressed, while patients with post-op neuroma along the course of the nerve had excision of the nerve proximal to the site of the injury and implantation to the muscle.

Results: Patient's had an average 2-year follow up (range 1.4-2.9 years). Pre-operative average VAS pain level was 7.4 (with ten on direct stimulation of the neuroma site), while post-operatively it dropped to an average of 2.3 (p<0.009). 17 out of 20 patients (85%) reported that they had 50% or more pain relief. Two patients (10%) reported 40-50% pain relief and another one patient (5%) reported no improvement. The quality of life improvement reported 18 patients (90%).

Summary: Patients with saphenous nerve neuropathy can successfully be treated with peripheral nerve surgery. Since no treatment algorithm is reported yet for saphenous nerve neuropathy, it will be presented, together with indications for the type and the timing of the surgery for a given chronic pain problem related to the saphenous nerve.