title: The sensate fibula osteocutaneous flap: neurosomal anatomy.
abstract: BACKGROUND
  Rapid return of oral sensation enhances quality of life following oromandibular reconstruction. For predictable reinnervation of flaps, a detailed knowledge of their nerve supply is required. This study was designed to investigate the cutaneous nerve supply of the fibula osteocutaneous flap.
  
  
  METHODS
  We dissected thirty-seven fresh cadaveric specimens to better understand the cutaneous innervation of the typical fibula flap that would be used in oromandibular reconstruction. In addition, ten volunteers were enlisted for nerve blocks testing the cutaneous innervation of the lateral aspect of the lower leg.
  
  
  RESULTS
  The lateral sural cutaneous nerve (LSCN) is generally considered to be sole cutaneous innervation to the lateral aspect of the lower leg; however, our analysis of the cadaveric specimens revealed dual innervation to this region. We identified a previously unnamed distal branch of the superficial peroneal nerve, which we have termed the recurrent superficial peroneal nerve (RSPN). Given the cadaveric findings, both the LSCN and the RSPN were tested using sequential nerve blocks in 10 volunteers. An overlapping pattern of innervation was demonstrated.
  
  
  CONCLUSIONS
  The lateral aspect of the lower leg has an overlapping innervation from the LSCN and the newly described RSPN. The overlap zone lies in the region of the skin paddle of the fibula flap. The exact position of the neurosomal overlap zone (N.O.Z.E.) may be an important factor in reestablishing sensation in the fibula's skin paddle following free tissue transfer.
authors.affiliation: Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, USA. Electronic address: jbboyd@ucla.edu.
authors.forename: J Brian
authors.initials: JB
authors.lastname: Boyd
authors.forename: Amy M
authors.initials: AM
authors.lastname: Caton
authors.forename: R Stephen
authors.initials: RS
authors.lastname: Mulholland
authors.forename: Lawrence
authors.initials: L
authors.lastname: Tong
authors.forename: Jay W
authors.initials: JW
authors.lastname: Granzow
mesh_terms: D005360:Fibula; D006801:Humans; D008334:Mandible / Q000601:surgery; D008339:Mandibular Neoplasms / Q000601:surgery; D064827:Myocutaneous Flap / Q000294:innervation*; D009407:Nerve Block; D010543:Peroneal Nerve / Q000033:anatomy & histology; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012867:Skin / Q000294:innervation
keywords: Innervated flap; Lateral sural cutaneous nerve; Oromandibular reconstruction; Recurrent superficial peroneal nerve; Sensate fibula flap