Distally based sural neuro-lesser saphenous veno-fasciocutaneous compound flap with a low rotation point: microdissection and clinical application

Fahui Zhang, Songqing Lin, Yiping Song, Guodong Zhang, Heping Zheng
Annals of Plastic Surgery 2009, 62 (4): 395-404
A distally based flap pedicled with the nutrient vessel of the sural nerve has been widely applied in the clinic. An attempt was carried out to modify the distally based flap pedicled with the nutrient vessel of the lower rotation point sural nerve to reconstruct the soft-tissue defects in foreleg. For cases with complex bone defects, this flap was unsatisfactory for the reconstruction. A compound flap pedicled with the sural nerve and the lesser saphenous veins was investigated in the lower extremities of 30 human cadavers arterially infused with red gelatin. The results showed that the sural nerve and the lesser saphenous vein had the identical source of blood supply as the nutrient vessel of muscle, fibula, and skin. The sural lateral artery, the peroneal artery, the lateral posterior malleolus artery, the perforating branches of the heel lateral artery, and the musculocutaneous perforators from the gastrocnemius formed a vascular chain for the sural nerve and lesser saphenous vein. The distally based compound flaps of sural nerve and lesser saphenous vein were applied for the reconstruction of 20 patients in the present study, from January 2004 to January 2007. The musculocutaneous flaps were applied for the repair of lower leg ulcers, osteomyelitis, or bone exposures in 10 cases and for medial calcaneus osteomyelitis in 3 cases. The osteocutaneous flaps and the myo-osteocutaneous flaps were used for tibial bone defects in 7 patients. In the 5- to 18-month follow-ups, all cases presented with survived flaps, healed wound surfaces, and with osteomyelitis. The musculocutaneous flaps were satisfactory and the appearance and movement of the donor site was normal. The transplanted fibulas of the patients with bone defects were healed after 3 to 4 months on average with a recovery of the ability for movement and support. The distally based compound flap pedicled with the nutrient vessel of sural nerve and lesser saphenous vein was convenient and reliable to employ due to its advantages of infection control, high percentage survival, and rapid healing. It was satisfactorily adapted for reconstruction of leg bone defects, missing skin, and foot and ankle defects.

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