title: The free peroneal perforator-based sural neurofasciocutaneous flap: a novel tool for reconstruction of large soft-tissue defects in the upper limb.
abstract: BACKGROUND
  The sural neurofasciocutaneous flap has been widely used for reconstruction of soft-tissue defects in the lower leg, ankle, and foot. It can provide a large amount of tissue without compromising the function of the leg. The authors report the applications of the free peroneal perforator-based sural neurofasciocutaneous flap.
  
  
  METHODS
  The free sural neurofasciocutaneous flap based on a single peroneal perforator is described. The peroneal perforator, which emerges from the posterior crural septum at the junction of middle and lower thirds of the fibula, was chosen as the pedicle of the flap. Six perforator-based sural neurofasciocutaneous flaps were transferred to resurface large soft-tissue defects in the upper limb. The size of the defects ranged from 15 × 6 cm to 45 × 10 cm.
  
  
  RESULTS
  All six flaps survived completely without necrosis. The area of the flaps ranged from 16 × 8 cm to 30 × 10 cm. The average diameter of the peroneal perforator ranged from 1.0 to 1.5 mm, and the length of the perforator pedicles ranged from 4 to 6 cm. One patient developed arterial thrombosis after surgery, which was treated by removal of the thrombus and reanastomosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months' follow-up. There were no serious donor-site complications.
  
  
  CONCLUSIONS
  The free perforator-based sural neurofasciocutaneous flap is a good alternative for reconstruction of extensive soft-tissue defects in the upper limb.
authors.affiliation: Shanghai, China From the Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiao Tong University.
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Wang
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Chai
authors.forename: Gen
authors.initials: G
authors.lastname: Wen
authors.forename: Pei-Hua
authors.initials: PH
authors.lastname: Cai
authors.forename: Lu-Yuan
authors.initials: LY
authors.lastname: Sun
authors.forename: Guo-Hua
authors.initials: GH
authors.lastname: Mei
authors.forename: Hong-Jiang
authors.initials: HJ
authors.lastname: Ruan
authors.forename: Sheng-He
authors.initials: SH
authors.lastname: Liu
mesh_terms: D000328:Adult; D001132:Arm / Q000601:surgery*; D005260:Female; D058752:Free Tissue Flaps; D006225:Hand / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013497:Sural Nerve