Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study

Turnbull, K., Bowness, J., Chisholm, F., Taylor, A., Halcrow, J., Grant, C. and Varsou, O. (2018) Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study. SINAPSE ASM 2018, Edinburgh, UK, 25 Jun 2018.

Abstract

The superficial peroneal nerve (SPN) provides cutaneous innervation to the distal anterolateral leg and dorsum of foot.1 Knowing the position where the SPN penetrates the deep fascia, to become superficial, is useful in clinical practice (e.g. ankle blocks and internal fixation of distal fibular fractures). However, there is variability in the literature as to where the SPN penetrates the deep fascia as well as the methodology to identify it with no standardised guidelines. Our primary aim was to identify this point and create a methodology protocol that could be implemented in clinical practice. The study involved sonography of living healthy adult volunteers and dissection of formalin-fixed cadavers with no past history of pathology or surgery affecting the SPN. During sonography, the bony prominences of the fibular head and lateral malleolus were identified and marked with a straight line. A 6-12 MHz linear array ultrasound probe was positioned anterior to the lateral malleolus and moved proximally to identify the location where the SPN penetrates the deep fascia to lie in a superficial plane. The lateral malleolus-fibular head (length of fibula) and lateral malleolus-SPN distances were measured. The distance of emergence from the deep fascia of the SPN anterior or posterior to the length of fibula was measured (fig 1). In the cadavers, a skin incision was made from the tibial tuberosity to the anterior intermalleolar line and the skin reflected laterally to a line posterior to fibula. The superficial fascia was explored to identify the SPN and branches (fig 2). The same bony landmarks/measurements as in the sonography were marked and measured to allow for comparison with the sonographic methodology. We successfully developed a protocol that can provide standardisation for identifying the SPN. This can reduce incorrect identification and improve success rates of clinical procedures, though individual variation must be considered. Reference: 1. STANDRING, S (Editor) 2008. Gray’s Anatomy The Anatomical Basis of Clinical Practice (Fortieth Edition). London: Churchill Livingstone ELSEVIER, page 1427. Acknowledgements: For their help and support in this study, we would to thank the volunteers, the anatomy technical staff, and the clinical skills suite manager from the University of St Andrews Medical School.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Varsou, Dr Ourania
• Authors: Turnbull, K., Bowness, J., Chisholm, F., Taylor, A., Halcrow, J., Grant, C., and Varsou, O.
• College/School: College of Medical Veterinary and Life Sciences > School of Life Sciences
• Copyright Holders: Copyright © 2018 The Authors
• Publisher Policy: Reproduced with the permission of the Authors