We will be demonstrating our technique for Serral nerve harvest. We have put the patient in prone position and we've marked out the lateral and medial heads of the gastroc muscle. We make an incision just distal to the popliteal fossa and identify the structures between the two heads of the muscle which will consist of the lesser saphenous vein and just adjacent to that and usually lateral to the vein is going to be the Serral nerve. We will go deep to the muscle fascia because the vein and nerve travel deep to the muscle fascia at this level. Having isolated the Serral nerve, we are going to now track its cephalad towards the popliteal fascia. In tracking the nerve cephalad, we are looking for the two contributions from the tibial nerve medially and the peroneal nerve laterally. These two contributions will provide the serral nerve. We make a counter-incision at the popliteal fossa so we can make a high division just proximal to where those two contributions join the serral nerve so we have maximum length of nerve to harvest. We have now divided the sural nerve just proximal to popliteal fossa to include the tibial component medially and the peroneal component laterally, which join to form the sural nerve. The sural nerve can then be harvested by taking a tendon stripper and going into the subfascial plane just immediately on top of the gastroc muscles, and we can take the tendon stripper to the distal aspect of the gastroc muscle, which is approximately at the middle and distal thirds of the lower leg. We can only go this far because following this, the nerve becomes subcutaneous, and if we want to harvest the subcutaneous component of the nerve, then we go to traditional stair step incisions coming from the lateral malleolus to the junction of the submuscular plane. When we take the sural nerve to the face for a cross-faced nerve graft, we want to identify all branches, starting with the branches to the lower lip depressors on the donor site, then the upper lip depressors on the donor site, then finally the orbitozygomatic branches of the facial nerve that will stimulate the orbicularis oculi muscle. So once we have identified all of the branches of interest of the facial nerve, we can then continue and isolate those branches that are upper lip elevators if we're looking specifically for smiling.

sural nerve harvest

prone position

gastrocnemius muscle

tendon stripper

cross-facial nerve graft