| Objective: Based on the previous rabbit model of sural neurofasciocutaneous flap,To compare the flap survive of different pedicle based sural neurofasciocutaneous flaps, so that a best operative technique on elevation of sural neurofasciocutaneous flap could be obtained and evaluation clinical results of such flap.Methods :①Animal model group: 35 New England rabbits were divided into four groups. Five rabbits in Group A were dissected for the anatomic study of the neurocutaneous flap. Red latex and gelatin-lead oxide used as vascular injections were injected into posterior tibial arteries of five rabbits in Group B and C respectively. In Group D, forty neurocutaneous flaps based on single perforator were elevated in the twenty rabbits to confirm the flap model.②Flap physiology and Hemodynamic Study Group: Based on the previous rabbit model of sural neurofasciocutaneous flap, forty flaps based on the four different pedicles were elevated. The flap was 7 cm×1 cm in size, and the pedicle was 0.5 cm in length. In Group A, ten flaps were elevated based on a single perforator pedicle; in Group B, ten flaps were elevated based on fascia pedicle; in Group C, ten flaps were elevated based on perforator-plus fascia pedicle, and in Group D, ten flaps were elevated and sutured in situ. Seven days after the operation, the flap survival rate was recorded, and the blood flow in the center of the flap was monitored by laser doppler flowmetry. All the data was analyzed by SPSS 11.0.③Clinical Applications Group: From the October 2005 , the new flap vascularised by the perforating vessels of saphenous and neurocutaneous vascular of the anterior cutaneous branch of the femoral nerve was used to repair skin and tissue defects of the patellar and peripatellar regions and the upper leg . the flap areas ranged from 30cm×15cm 15cm×7cm .the rotation angle of the flap is from 100°to 180°.Results:①Animal model group: he sural nerve originated from posterior tibial nerve, pierced the lateral head of the gastrocnemius in the region of the popliteal fossa, descended obliquely to the exterior, penetrated into the deep fascia at about 5.42±0.15 cm above lateral malleolus, and descended vertically to lateral malleolus. Its concomitant artery originated from deep femoral artery with initial diameter 0.73±0.11 mm and extended to the lateral malleolus along the sural nerve. A perforating branch of posterior tibial artery at the position of the calcaneus originated from the midpoint of the connecting line between the medial malleolus and the calcaneus (initial diameter 0.45±0.01mm). The perforating branch traversed the calcaneus to the region of the lateral malleolus, and anastomosed to the concomitant artery of the sural nerve, forming a vascular plexus around the sural nerve. In Group D, two of these cases were excluded due to infection. The survival area of the other 38 flaps 10 days after the operation was 78%±1.5%.②Flap physiology and Hemodynamic Study Group: Seven days after the operation, the flap survival rate and the mean blood flow of the flap was (74±2.7) % and 43.39 respectively in Group A, (60±2.5) % and 28.96 respectively in Group B, (75±3.5) % and 48.85 respectively in Group C, and 0.00% and 8.10 respectively in Group D. There was no statistical significant between Group A and C.③Clinical Applications Group: In 13 cases, the flap survived completed. necrosis of the distal one fifth or one seventh of flap occurred in 3 flaps, and the wounds was covered by the daily dressing or advanced skin flap. All the patients were followed up for 6 to 24 months ,the color and the texture of flap were excellent . The appearance and functional results were satisfactory and no complaint in donor site.Conclusion:①Animal model group: This perforator based sural neurocutaneous flap in rabbit is a good experimental model which may serve as a reproducible and reliable flap model for additional studies in this field.②Flap physiology and Hemodynamic Study Group: The sural neurofasciocutaneous flap can be successfully elevated based on a single perforator, which can be regarded as a modified operative technique.③Clinical Applications Group: The operation combines the advantage of both the perforator flap and the neurotaneous axial flap ,enlarges the size of the flap of the anteromedial aspect of the thigh. It provided a new practical method to repair the large defect of the lower extremity .
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