POSTERIOR FEMORAL CUTANEOUS NERVE IN THE LEG: SURPRISING FACTS WITH GREAT CONSEQUENCES!

Abstract

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Background. Problems and failures in regional anesthesia procedures distal to the popliteal region might occur although blocks of the sciatic and femoral or saphenous nerve were performed successfully. Aim. One of the reasons for failures could be the posterior femoral cutaneous nerve (pfcen) with a much more distal innervation area as described. Material and Methods. In total 123 lower extremities embalmed with Thiel’s method were investigated by dissection. The course of the pfcn was documented from the subgluteal fold to the most distal macroscopical dissectable branch. In a large subgroup (83 of 123 extremities) the topography in regards to other structures, such as the small saphenous vein, was also inspected and documented. Results and Discussion. The pfcn ended in the popliteal fossa or the proximal leg in 78 of the 123 (63.4%) dissected legs. The remaining 45 nerves (36.6%) extended further distally and were divided into several subgroups depending on their distance from the tip of medial malleolus. In two cases to the innervation of periosteum were found (one on the fibula, one on the calcaneus). Conclusions. The guidelines for regional anesthesia procedures distal to the popliteal fossa should be revised. The pfcn is a relevant nerve that plays a much greater role in the skin innervation of the leg than previously thought. Ultrasound-guided blockade of the pfcn should be routinely implemented.