Anatomy And Clinical Application Of Free Lateral Sural Neurocutaneous Flap

Background: Given the benefits of the perineural vascular network,pedicled neurocutaneous flaps have been popular in reconstruction of soft tissue defects in extremities.In this study,the anatomy of the lateral sural cutaneous nerve(LSCN)and its accompanying artery,the superficial lateral sural artery(SLSA),was investigated,and a free innervated flap based on the SLSA was designed for soft tissue reconstruction.Methods: Four fresh adult cadaver legs perfused with red latex were dissected to observe the course and relationship of the LSCN and SLSA.Based on the anatomical study,a free lateral sural neurocutaneous flap was designed and used to repair soft tissue defects in five patients from January 2014 to December 2015.Four patients were male and one was female,with an average age of 35 years.The size of the soft tissue defects ranged from 9 × 7 cm to 20 × 10 cm.Results: The SLSA was found to accompany the LSCN in all 4 specimens.It originated directly from the popliteal artery 4.1 ± 1.5 mm above the fibular head,where its outer diameter was 1.08 ± 0.14 mm.The SLSA gave rise to branches that followed the nerves and ramified into terminals at the ramification of the nerves.Several perforators penetrated from the crural fascia and anastomosed to the SLSA,creating a fine anastomotic network.The perineural vascular network not only supplies the nerve but also nourishes the skin over it.All five flaps survived completely.The size of the flap ranged from 12 × 6 cm ? 18 × 10 cm.Follow-up ranged from 6 to 42 months.No additional debulking was necessary,and the overall contour after reconstruction was satisfactory.Conclusion: There is a true artery called the SLSA that accompanies the LSCN and can be used for free sensate flap transfer.