The free vascularized sural nerve graft

Abstract

The sural nerve was described as a new donor nerve of the free vascularized nerve graft in a fresh cadaver's dissection and in four clinical cases. The vascularized sural nerve is nourished by the cutaneous branch of the peroneal artery or the muscular perforating branch of the posterior tibial artery in our grafts. Compared to other vascularized nerve grafts, the sural nerve has many advantages: 1) A "two- or three-fold nerve graft" can be designed on itself without damage to the blood supply of the nerve, 2) survival of the nerve can be reasoned by the accompanying flap and the flap can close the skin defect simultaneously without additional vascular anastomosis, and 3) sensory loss at the donor site is negligible. The final extent of sensory recovery in our clinical cases could require several months, but a quickly advanced Tinel's sign suggested the technique's superiority.

Vascularized Ulnar Nerve Graft: 151 Reconstructions for Posttraumatic Brachial Plexus Palsy

“…The mean nerve defect was not very long (7 cm), but all the repairs were performed in severely scarred beds. 28 Compared with nonvascularized grafts, results were found to be superior. 24 Taylor presented four cases with good functional results after long-term follow-up (Ͼ20 years).…”

The Tibial Second Toe Vascularized Neurocutaneous Free Flap for Major Digital Nerve Defects

“…First, the morbidity on the donor site might far outweigh the benefit of restoring a digital nerve, and second, the skin carried is so thick that at best it is only appropriate for palmar defects. 17,20,21 Koshima et al 22 refined the Rose and Kowalski 4 deep peroneal vascularized nerve graft to include the skin overlying the first web for reconstructing a neurocutaneous defect in the finger. They reported good clinical results in a patient.…”

Bilateral inferior alveolar nerve reconstruction with a vascularized sural nerve graft included in a free fibular osteocutaneous flap after segmental mandibulectomy

“…The sural nerve has commonly been used as a nerve graft donor site and runs near the skin paddle of the fibular osteocutaneous flap. Previous studies demonstrated that the combined flap of the sural nerve and fibular osteocutaneous flap was easily and safely elevated, thereby preserving nutrient vessels from the peroneal perforators to the sural nerve . However, the blood flow to a sural nerve graft combined with a fibular osteocutaneous flap has not yet been assessed.…”