Vascularized Sural Nerve Flap for Complex Peripheral Nerve Injuries Using Perforator to Perforator Techniques
Mohammed Hassan El Fahar, MD Ph.D EBOPRAS
Mansoura Univeristy, Mansoura, Egypt
The superiority of the vascularized nerve graft over the traditionally used nerve graft, especially in a scarred recipient bed is very well documented. Longer defects are best repaired primarily with vascularized tissues. The vascularized sural nerve is one option of the vascularized nerves that could be used. In our series we tried to investigate the harvesting the vascularized Sural nerve flap (VSNF) based on gastrocnemius perforator only for reconstruction of different nerve defects.
Patients and methods
Nine patients with evident nerve injuries diagnosed clinically and evidenced by nerve conduction and EMG studies were included in this study. The vascularized sural nerve flap was divided and folded to bridge the desired girth.
Results
In our study, the average nerve gap was 9.1±1.1 cm. The VSNF was used to reconstruct patients with peripheral nerve injuries in the extremities. There were 5 cases of median nerve injury, 2 for posterior tibial nerve injury and two cases of peroneal nerve injury. The main cause of injury was machinery accidents and it represented 67%. The average Vascularized Sural Nerve flap (VSNF) that was harvested was 25.2 ±4.2 SD cm. The shortest was 20 cm and the longest was 31cm. The follow-up period was 26.4± 2.6 months.
Conclusions
Vascularized sural nerve flap is a very promising solution for treatment of long gapping neuroma in peripheral nerve. Sural nerve flap is one of the best donor sites with constant anatomy. Supermicrosurgy allows us to anastomose very short
pedicle without deep muscular dissection.
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