Anat Cell Biol.  2019 Sep;52(3):262-268. 10.5115/acb.19.031.

Morphology of saphenous nerve in cadavers: a guide to saphenous block and surgical interventions

• Ghosh A
• Chaudhury

• KMID: 2459541
• DOI: http://doi.org/10.5115/acb.19.031

Abstract

The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. The average distance of origin of saphenous nerve from inguinal crease was 7.89±1.42 cm, the distance from upper end of medial border of patella to saphenous nerve at that level was 8.11±0.85 cm, distance from tibial tuberosity was 7.53±0.98 cm and from midpoint of anterior border of medial malleolus was 0.45±0.14 cm. Saphenous nerve provided two infrapatellar branches at the level of mid to lower limit of patellar ligament in 90% cases. It was in close contact or adhered to great saphenous vein across the lower 2/3rd of leg lying either anterior, posterior or deep to the vein. The saphenous nerve terminated by bifurcating proximal to medial malleolus in majority of cases though no obvious bifurcation was observed in 9.52% cases. The detailed morphology, relations and the distances from palpable bony landmarks may be helpful for clinicians to achieve successful saphenous nerve block and to avoid saphenous nerve damage and related complications during orthopedic procedures.

Keyword

Saphenous nerve; Saphenous nerve block; Saphenous nerve injury; Relation of saphenous nerve with great saphenous vein

MeSH Terms

Anesthesia and Analgesia
Ankle
Cadaver*
Deception
Formaldehyde
Knee
Leg
Lower Extremity
Nerve Block
Nerve Compression Syndromes
Orthopedic Procedures
Patella
Patellar Ligament
Saphenous Vein
Veins
Formaldehyde

Figure

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  Fig. 1 Schematic diagram showing measurement points. AB, distance from inguinal crease to origin of SN from femoral nerve; AH, adductor hiatus; BC, diameter of SN at origin; DE, distance from upper margin of patella to lowest branch of NVM; FA, femoral artery; FN, femoral nerve; FV, femoral vein; GH, distance from tip of medial malleolus to point of adherence between SN and GSV; GSV, great saphenous vein; LK, distance between patella to caudal limit of adductor canal; MM, medial malleolus; NVM, nerve to vastus medialis; OP, distance between anterior border of MM to SN; PT, patella; QR, diameter of SN at level of MM; SN, saphenous nerve; SR, sertorius; TT, tibial tuberosity; VL, vastus lateralis; VM, vastus medialis; MN, horizontal distance between TT and SN.

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  Fig. 2 Close proximity of saphenous nerve (SN) and nerve to vastus medialis (VM) muscle (at tip of the probe) in middle third of thigh. GSV, great saphenous vein; NVM, nerve to vastus medialis; RF, rectus femoris.

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  Fig. 3 Infrapatellar branches of saphenous nerve (SN) at lower limit of patellar ligament (PL). TT, tibial tuberosity; IPB 1&2, infrapatellar branch 1&2.

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  Fig. 4 Figure showing the course of saphenous nerve and great saphenous vein through lower limb. SN, saphenous nerve; GSV, great saphenous vein.

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  Fig. 5 Relation of saphenous nerve (SN) and great saphenous vein (GSV).

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  Fig. 6 Terminal divisions of saphenous nerve (SN) proximal to medial malleolus. SN AD, anterior division of saphenous nerve; SN PD, posterior division of saphenous nerve; GSV, great saphenous vein; MM, medial malleolus; TP, tibialis posterior tendon.

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  Fig. 7 Terminal divisions of saphenous nerve along anterior border of medial malleolus. SN AD, anterior division of saphenous nerve; SN PD, posterior division of saphenous nerve; GSV, great saphenous vein; MM, medial malleolus; TP, tibialis posterior tendon; TA,- tibialis anterior tendon.

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  Fig. 8 Mode of termination of saphenous nerve (SN). MM, medial malleolus.

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  Fig. 9 Saphenous nerve crossing the great saphenous vein from anterior to posterior deep to vein in lower leg. SN, saphenous nerve; GSV, great saphenous vein.

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