title: Clinical and anatomical study of the distally based lesser saphenous veno-lateral sural neurocutaneous flap for lower extremity coverage.
abstract: BACKGROUND
  The distally based sural flap has been widely and successfully used to reconstruct soft tissue defects of the distal third of the lower leg and foot. Sensory loss and venous congestion are possible complications of this treatment, but there has been limited research focused on improving the sensory loss and veneous congestion. This study aimed to determine the spatial relationship between the lesser saphenous vein and the cutaneous nerves, the venous anatomy in the lower leg, and the nerve distribution in the lateral dorsum of the foot, and we presented our clinical experience.
  
  
  METHODS
  Twenty freshly amputated lower limbs were dissected in the 2 h following amputation. The lesser saphenous vein, medial/lateral sural nerve, and sural nerve were identified. Based on the anatomical studies, an island flap supplied by the vascular axis of the lesser saphenous vein and the lateral sural nerve was designed for clinical reparative applications in 24 cases.
  
  
  RESULTS
  We indicated the spatial relationship between the lesser saphenous vein and the cutaneous nerves and the venous anatomy in the lower leg. Among 24 flaps, 21 showed complete survival (87.5%), while marginal flap necrosis occurred in two patients (8.33%) and distal wound dehiscence in another (4.17%). No symptomatic neuromas were observed. Their appearance and functioning were satisfactory, with filling maintained in the heel and lateral side of the foot.
  
  
  CONCLUSIONS
  The distally based lesser saphenous veno-lateral sural neurocutaneous flap provides effective coverage of variable-sized soft tissue defects on the lower third of the lower leg and foot, without sensory loss and venous congestion.
authors.affiliation: Department of Orthopaedics, Minhang Center Hospital, Shanghai Jiao Tong University School of Medicine, 170 Xisong Road, Shanghai, 201199, People's Republic of China.
authors.forename: Huijie
authors.initials: H
authors.lastname: Gu
authors.forename: Zhuyou
authors.initials: Z
authors.lastname: Xiong
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.forename: Guangzao
authors.initials: G
authors.lastname: Li
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D012501:Saphenous Vein; D013497:Sural Nerve; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D055815:Young Adult