A reliable technique of free vascularized sural nerve grafting and preliminary results of clinical applications.
A technique of harvesting a free vascularized sural nerve graft based on either the cutaneous branch of the peroneal artery or the muscular perforating branch of the posterior tibial artery is described. Anatomic dissections with dye injection studies confirmed the reliability of this blood supply to a 25 cm long segment of the sural nerve. The sural nerve can be sectioned into as many as four segments while safely maintaining each segment's vascularity through intact fascia. A skin monitor can be elevated with the nerve to monitor vascular patency. The free vascularized sural nerve was used to reconstruct 16 nerve defects in the upper extremity. All 13 skin monitors elevated have survived. Early follow-up (range, 2 to 31 months) has shown encouraging clinical recovery. Although our preliminary results are difficult to compare with other series, this technique appears promising in clinical circumstances when interfascicular nerve grafting is indicated but the recipient bed is heavily scarred and poorly vascularized.
Doi
K
K
Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Kuwata
N
N
Sakai
K
K
Tamaru
K
K
Kawai
S
S
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013127:Spinal Nerves / Q000637:transplantation*; D013497:Sural Nerve / Q000033:anatomy & histology / Q000637:transplantation*; D013524:Surgical Flaps; D014654:Vascular Patency