The Blood Supply Research And Clinical Application Of Sural Neurofasciocutaneous Flap

Objectives To investigate the relationship between the blood supply of the sural nerve fasciocutaneous flap and the perforator vessel,and provide anatomical data for clinical application.To investigate the clinical effects of distally based sural fasciocutaneous flap for retrograde repair of distal leg,ankle and foot soft tissue defects.Methods 1 Blood supply study: There were 26 healthy volunteers,18 males and 8 females,with an average age of 38.5 years.The ES-1000 SPM Doppler was used to detect the perforator vessels around the projection surface of the distal 1/3 segment of the sural nerves.Detection range: 2cm from the anterior and posterior projection lines of the sural nerve(referred to as the projection line),and from the tip of lateral malleolus to 15 cm above it.Each perforator location was traced and the data obtained were statistically analyzed.2 Clinical application study: From February 2014 to January 2018,65 cases of soft tissue defects in the mid-distal and ankle areas of the lower leg were repaired with distal pedicled sural nerve fasciocutaneous flaps.According to the case data,whether the distal sural nerve contained in the flap was damaged,it was divided into two groups: 46 cases in the control group(non-injured sural nerve group)and 19 cases in the experimental group(sural nerve distal injury group).Observe the number of partial necrosis of flaps in both groups and perform statistical analysis.Results 1 Blood supply study: A total of 417 vascular perforators were detected on 52 sides,4 to 14 on each side(8.02±2.16).The average number of perforation points on the front and back of the projection line was 5.77 and 2.44,respectively;there was a significant difference between the tests and the front side was more than the back side.2 Clinical application study: In the control group,the flap area was 4.0cm×4.0cm~18.0cm×12.0cm,and the flap area was 6cm×5cm~18cm×15cm.There was no statistically significant difference between the two groups in terms of gender and age.The flap parameters(valve length,flap width,pedicle length,pedicle width,total length of flap,length-width ratio)were comparable in both groups.The test was not statistically significant.Partial necrosis occurred in 4 cases in the control group;partial necrosis occurred in 2 cases in the experimental group;the test was not statistically significant.During follow-up up to 2 months,all wounds healed well and no ulceration occurred.The color of the flaps was close to normal and the texture was good.Conclusions 1 The distal 1/3 of the sural nerve is rich in vascular perforators,and the anterior side is multiple and posterior.It provides anatomical basis for the blood supply of the reverse fasciocutaneous flap pedicled with distally injured sural nerve.2 No matter whether the distal part of the sural nerve wrapped by sural nerve fasciocutaneous flap is damaged,the survival rate is the same.All these are effective methods to repair the soft tissue defects of the distal part of the calf,ankle and foot.