The Study On The Sensory Reconstruction In Denervation Areas After The Operation Of Reversed Island Pedicled Sural Flap

Objective To explore the method of sensory reconstruction after the operation of reversed island pedicled sural flap and evaluate its therapeutic effect of clinical application.Methods Choose 11 adult cadaver specimens with 20 lower limbs, dissect sural nerve for observing its type, course and distribution.Choose 28 clinical cases with traumatic soft tissue defects in heel, all had recepted the treatment of reversed island pedicled sural flap,they were divided into 2 groups: the cases from May 2005 to December 2006 were selected as control group, the cases from January 2007 to February 2008 were selected as experimental group. All flaps were innervated by anastomosing the distal end of the sural nerve in the flaps and the recipient nerve (superficial peroneal nerve) in end to end or end to side in experimental group cases, but no innervation in control group. All patients were evaluated at 3, 6, 9 and 12 months on the postoperative follow-up parameters, including flap contour, flap stability, locomotor activity, touch sensation, pain sensation, static two-point discrimination, thermal sensibility, and the skin sensory recovery level in lateral dorsum of foot.Results The medial sural nerve and lateral sural nerve converge into the main trunk of sural nerve above the lateral malleolus about 147.66±10.52mm, the innervation area of sural nerve include posteral calf, lateral heel , lateral dorsum of foot and the 4th , 5th dorsum of toe. The diameter of the main trunk of sural nerve, medial sural nerve and lateral sural nerve is (3.45±1.05)mm, (1.57±0.43)mm and (2.60±0.63)mm, Their length o is (139.40±38.39)mm, (241.20±30.79)mm and (199.20±40.03)mm,respectively. All flaps survived in both groups.The flaps have good blood suppy and primary healing. All the 15 cases in the control group followed up 10-15months (12 months on average ), among of them, 13 have good shape , 2 are fat and clumsy , the rate of good sensory recovery is 6.67%. 5 patients have been burned 7 times owing to poor sensory recovery , 2 patients had superficial ulceration. All patients have protective sensory in lateral dorsum of foot , the rate of good sensory recovery is 13.33%. All the 13 cases in the experimental group followed up 9-15 months (12 months on average), among of them, 10 have good shape , 3 are fat and clumsy, the rate of good sensory recovery is 53.85%, no adustum and ulceration. All patients have protective sensory in lateral dorsum of foot , the rate of good sensory recovery is 61.54%.Conclusion1. The main innervation area of sural nerve is posteral calf, lateral foot , there will be sensory disability in the above areas after operation of reversed island pedicled sural flap.2. Anastomosing the proximal end of sural nerve and superficial peroneal nerve together will be good for the sensory recovery in flap and lateral foot in repairing soft tissue defects in heel with reversed island pedicled sural flap...