CLINICAL UTILIZATION AND COMPLICATIONS OF SURAL NERVE BIOPSY

Surgeons frequently perform sural nerve biopsy as part of the work-up of patients with peripheral neuropathy. The indications for the proced ure, therapeutic value, and complications associated with the procedur e have received little attention in the surgical literature. A retrosp ective chart review of 60 patients with the suspected diagnosis of per ipheral neuropathy undergoing sural nerve biopsy was performed. Vascul itis was suspected in 29 (48%) patients undergoing biopsy. This diagno sis war, confirmed in 6 of the 29 patients and resulted in the alterat ion of therapy in 31% of patients with this suspected diagnosis. In 27 (45%) patients, the etiology of their peripheral neuropathy was unkno wn. Twelve (44%) patients in this group had sural nerve pathology; how ever, no change in therapy was required. Ten patients in our series ha d associated malignant tumors; some of these patients were diagnosed a fter referral for sural nerve biopsy. Twenty-five (42%) patients remai ned undiagnosed after biopsy. Nerve conduction studies were performed in 14 (22%) patients. Thirteen patients with abnormal lower extremity nerve conduction studies had 6 normal and 7 abnormal biopsy results. T he one patient with a normal study had a normal nerve biopsy result. T here were six (10%) patients with wound infections, seven (12%) patien ts with delayed wound healing, and three (5%) patients with new onset of chronic pain in the distribution of the sural nerve, for an overall complication rate of 27%. There was no correlation between the preope rative use of antibiotics, type of local anesthetic used, or length of nerve excised and complication rate. We conclude that the complicatio n rate after sural nerve biopsy is significant. Strict criteria should be employed in selecting patients for sural nerve biopsy including a careful neurologic history and physical examination, nerve conduction studies, appropriate work-up for vasculitis if suspected, and implemen tation of a search for malignancy if this is not apparent. If the diag nosis is still in question, then sural nerve biopsy would seem appropr iate, especially in patients with suspected vasculitis.