Anatomical Study And Clinical Application Of The Distally Based Compound Flap Pedicled With The Nutritional Vessels Of Sural Nerve

Objective:To explore the anatomy and the clinical application of distally based compound flap pedicled with the nutritional vessels of sural nerve in repairing the skin and bone defect at the middle and lower leg.Methods:Thirty adult cadaveric low limbs perfused with red gelatin through anterior tibial artery and popliteal artery were used for this study.The skin under the plane of middle and lower 1/3 leg was in good condition.with the naked eyes or the assistance of magnification loupe,we concentrated our study of the origin,course and distribution of sural nerve and its nutritional vessels within the scope from the tip of external malleolus and 10cm above it.A soft ruler was used to measure the outer diameter and its distance away from the tip of external malleolus.The focus of our study:①.the origin,branches and anastomosis of the vessels of sural nerve-small saphenous vein;②.he relationship between the nutritional vessels of sural nerve-small saphenous vein and blood supply to fibula,gastrocnemius muscle and soleus muscle.The mimic operation of distally based compound flap pedicled with the nutritional vessels of sural nerve were designed on an other 2 samples.Results:1.Anatomical study proved:①.4-8 nutritional vessels of sural nerve -small saphenous vein were the intermuscular perforators of peroneal artery,the furthermost one located at(1.0±1.3)cm above the tip of external malleolus with diameter(0.6±0.2)mm;②.2-6 musculocutaneous perforators were given off by the artery of outer head of gastrocnemius muscle to supply nutrition to the sural nerve-small saphenous vein;③.intermuscular perforators from peroneal artery supplied blood to fibula and outer head of soleus muscle.the perforators with an average outer diameter of(1.3-1.6) cm gave off cutaneous branch,fascial branch and nutritional vessels to the sural nerve-small saphenous vein,which formed the vessel chain of the sural nerve-small saphenous vein,sub-fascial and suprafascial vessel net.The nutritional vessels of the sural nerve-small saphenous vein and the vessels supplying blood to the adjacent muscle,bone and skin are homogenous,they formed a multi-segmented,chain-liked longituditional vessels accompanying the full length of nerve and superficial nerve。It was the anatomical basis for the distal based compound flap based on nutritional vessels of sural nerve.2.All flaps survived.About all,2 cases have necrosis of distant part but with the development of subcutaneous granulation tissue.companying with subcutaneous tissue,lease heeled after dressings change,the other heeled after skin grating.all cased were followed up for 6 months,they all have normal gait,and the flap are wear-resisting and has good sensation.Conclusion:The results suggest that the nutrient vessels of sural nerve and small saphenous vein are homologous with the nutrient vessels of muscle,bone and skin.The flap is easy to design and dissect in the adjacent place,blood supply is reliable,it is suitable and small wound,operating conveniently,it is a good donor area in repairing the soft tissue defect of the middle and lower leg.