Clinical Efficacy Of Modified Sural Neurotrophic Vascular Fascial Flap

Objective Research on the effect of different surgical methods on the sensory area of the innervation area and the survival of skin flap,a number of studies have been adopted,including preserving the sural nerve in situ,cutting off the sural nerve,isolating the sural nerve and the outer membrane as well as retaining the peripheral vascular network around the flap.Simultaneously,statistical analysis is used to evaluate the effect on patients with different surgical methods,which provides the reference for the improvement of surgical methods and the quality of life.Methods From January 2011 to June 2017,15 cases of qualified ankle wounds are selected from the plastic surgery of the Second Affiliated Hospital of Medical University Of Anhui.We use the retrograde sural nerve vascular fasciocutaneous flap to repair the wound.Among them,9 cases are men and 6 cases are women.The maximum age is 68 years old and the youngest is 6 years old.Wound area ranges from3.5 cm×4.5cm to 7.5 cm×9.0 cm.The patients are divided into 3 groups:A,B,C.Group A,5 cases,the average age is(34.8±22.57)years old,the average area of the wound surface is(32.1+18.23)cm~2.The operation is to cut off the sural nerve and carry it into the skin flap;Group B,7 cases,the average age is(39.43±17.51)years old,the average area of the wound surface is(33.93±20.4)cm~2.The operation is to preserve the sural nerve and its outer membrane in situ;Group C,3 cases,the average age is(40±12.77)years old,the average area of the wound surface is(24.17±5.35)cm~2.The operation is to separate the sural nerve outer membrane,preserve the sural nerve in situ and transfer the flap with the epineurium and peripheral vascular network.Among the 3 groups,we compare the blood flow of the skin flap,immediate sensation in the innervation are after the recovery of anesthesia(two-points discrimination),ankle function score and quality of life from 6 months to 1 years after operation.Results after operations,15 cases of skin flap all survive,of which 2 cases are erosive and healed after 7-12 days.Among the 3 groups,the blood flow is normal.The perceptions of the dominance of the lateral nerve both exist and have no significant differences preoperatively.The immediate feeling of the group A was significantly worse than that in group B?C postoperatively.There was no significant difference between the group B and C.The duration of follow-up is 3-18 months.Patients in group A restore part of the protective sensation,nonetheless,QST and two-points discrimination are still worse than that of group B and C.All patients walk normally and all flaps are flat,wear-resisting and achieve satisfactory appearance.Conclusion Retrograde sural nerve vascular fasciocutaneous flap has reliable blood transport and does not need to damage the well-known blood,which can achieve satisfying aesthetic outcomes.But the traditional surgical approach is to call for the amputation of the sural nerve,which can cause sensory loss in the nerve control area,Although long-term follow-up revealed a certain degree of recovery,it is still worse and patients'long-term life satisfaction declines.The retention of the sural nerve is beneficial to the retention of the sensory area of the patient,and there is no significant difference in postoperative feeling.We also found that the separation and carrying of the external membrane and vascular network do not significantly promote the survival of the flap,and the survival rate of the flap is not statistically significant.The operation time is long.The operation is difficult that needs the microsurgery experience.Underdeveloped area is difficult to carry out.Therefore,in conclusion,if the neurovascular anatomy is clear and the blood supply of the flap is sufficient,it can be used to restore the sense of the nerve control area by preserving the sural nerve.If there is a variation of blood vessel or partial blood supply,it can also be used to cut off the nerve operation method,by preserving the peripheral vascular network of the nerve to increase the blood supply of the flap,to prevent the postoperative skin flap necrosis.