Neurocutaneous Flap Research Articles

Postoperative nursing of open tibial fracture fibula with skin and sofe tissue defects patients treated by neurocutaneous flap

Objective To summarize the application of external fL ation and closed suction drainage combined with tibial neurocutaneous flap,open fracture of fibula skin and soft tissue defects after the effects of care and functional training.Methods Open tibial and fibula open fracture,the patients underwent fracture reduction external fixation,the use of VSD to be fresh granulation tissue,infection control,the use of flaps with neurotrophic lack of treatment of skin and soft tissue loss,postoperative care and rehabilitation to be special.Results Provided special care and postoperative rehabilitation,the flap survived well.Patients were followed up for 1 to 10 months.Color similar to the flap and strrounding skin,no fat,two points discrimination of 6 -8 mm.Patients can normally walk after surgery,and no ulceration occurred with the force at the free flap.Condu~ons Extermal fixation and closed suction drainage combined with neurotrophic flap tibia and fibula open fractures with skin and soft tissue defect,postoperative care and rehabilitation to the special treatment,results were satisfactory. Key words: VSD; Neurocutaneous flap; Nursing; Rehabilitation

An Anatomical Study of the Saphenous Nerve, Artery, and Artery Perforators Within the Thigh Using Cadaveric Dissection

Although the saphenous flap has been used in reconstruction as a free flap, there has not yet been an anatomic study about the perforators of the saphenous artery. The aim of this study is to investigate the anatomy of the saphenous artery and the number and locations of its perforators. We dissected parts of 10 legs from 5 cadavers. Measurements of the positions of the dissected saphenous arteries and their perforators were taken from the medial epicondyle of the femur. We observed the origin, end point, and the diameter of each of the arteries, and we investigated the numbers and locations of both septocutaneous and musculocutaneous perforators. The average length of saphenous artery was 14.8 cm, and it was located 12.0 cm above the medial epicondyle of the femur. The average diameter was 1.63 mm. A median average of 4 perforators branched out from a single saphenous artery. There was a median average of 2 septocutaneous perforators and 2 musculocutaneous perforators from the saphenous artery. The perforators were mainly located at 7 cm proximal to the medial epicondyle of the femur. The saphenous artery has many perforators and is therefore useful as the pedicle of the perforator flap. The saphenous artery perforator flap can be designed within 7 cm proximal to the medial epicondyle of the femur. Our results may be helpful in the applications of the neurocutaneous flap using the saphenous artery or the perforator flap based on septocutaneous perforators.

Distally-based sural neurocutaneous flap for repair of a defect in the ankle tissue

The Achilles tendon and the bones around the foot and ankle are often exposed after trauma and infection because of the thinness of the soft tissue. Many surgeons consider the distally-based neurocutaneous flap as the first choice for reconstructing soft tissue defects around the ankle, as it provides robust axial perfusion for flaps and is easier to transpose than random pattern local flaps or free flaps. We report here a series of 23 cases of reconstruction of the foot and ankle using a distally-based sural neurocutaneous flap. This flap, which measured from 5 × 4 cm2 to 15 × 10 cm2, was transferred to cover defects in the soft tissues of the foot and ankle. The short saphenous veins were ligated in 12 cases and retained in the remaining 11 cases. All flaps survived, but two cases with retained short saphenous veins developed venous congestion, including one that progressed to distal necrosis. In conclusion, the distally-based sural neurocutaneous vascular flap provides a valuable tool for the repair of defects in tissues around the ankle.

Distally Based Dorsal Pedal Neurocutaneous Flap for Forefoot Coverage

The authors describe their experience with the use of the distally based dorsal pedal neurocutaneous flap for distal foot coverage. Ten patients underwent reconstruction with 13 flaps between 2004 and 2008. One patient suffered from a traffic accident and 9 from electrical injury. All of the soft tissue defects resulted in metatarsophalangeal joint and phalanx bone exposure. The size of the flaps ranged from 6 × 2 cm to 11 × 6 cm. The flaps were elevated based on intermediate or medial dorsal pedal nerves. Nine flaps were harvested in first stage to repair the distal foot. Among them, 3 showed partial necrosis in the distal region because of venous insufficiency. Four flaps underwent a surgical delay procedure in the first stage and were then transferred to reconstruct phalanx wounds in the second stage, surviving completely. All patients were satisfied with their reconstruction and donor site contour. The distally based dorsal pedal neurocutaneous flap can be used to repair the distal foot soft tissue defects, providing sufficient skin territory and excellent aesthetic and functional recovery. Surgical delay effectively enhances the distally based dorsal pedal neurocutaneous flap survival, particularly for the large size flaps.

The superior gluteal neurocutaneous flap transfer for sacrococcygeal pressure sores

Objective To observe the clinical outcomes of the superior gluteal neurocutaneous flap for sacrococcygeal pressure sores. Methods Twelve cases with sacrococcygeal pressure sores were covered by the superior gluteal neurocutaneous flap from May 2005 to Nov. 2009. The sore size ranged from 15 cm ×30 cm to 5 cm × 8 cm, while the flap size ranged from 17 cm × 32 cm to 10 cm× 12 cm. Results All 12 flaps survived totally with the pressure sores healed. The longest follow-up time was four years, the short follow-up time was half a year, the average time was 2.5 years. The superior gluteal neurocutaneous flap was good blood circulation, pressure sores not recur. Conclusion The superior gluteal neurocutaneous flap is a good treatment for sacrococcygeal pressure sores for its reliable blood supply and simple harvesting. Key words: Pressure sores; Superior gluteal neurocutaneous flap; Transplantation; Microsurgical operation

Anatomical basis of lateral antebrachial neurocutaneous flap pedicled with inferior cubital artery perforator

Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through V-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint. Key words: Inferior cubital artery; Flap; Lateral antebrachial cutaneous nerve; Repair

Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap

To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap. The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques. The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%. According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.

Topographical anatomy of the dorsal branch of the ulnar nerve and artery: a cadaver study

The surgical anatomy of the dorsal branch of the ulnar nerve and artery on the dorsal aspect of the hand is important in design of neurocutaneous flaps for reconstructive surgery and serves as a donor site for nerve grafts. In this study, the course, location, and diameter of the dorsal branches of the ulnar nerve and artery were studied from anatomical and reconstructive perspectives. Upper limbs of 14 (7 left and 7 right) and 22 formalin-preserved adult cadavers (15 left and 7 right) were dissected in two different centers. The diameters of the ulnar nerve, artery, and their dorsal branches were measured at selected reference points. The distances to specific anatomical landmarks were also measured, during their courses from the proximal forearm towards the middle phalanges of the 4th and 5th fingers. Our data may facilitate the design of neurocutaneous flaps nourished from the dorsal branches of the ulnar nerve and artery, and may aid in the harvesting of nerve grafts from the dorsal branch of the ulnar nerve, and provide a safe surgical approach to the dorsum of the hand.

Applied anatomy of thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators

Objective To provide anatomical basis for the thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators. Methods ① The course and distribution of thigh medial cutaneous nerve. ②Anastomosis between descending genicular artery perforators and thigh medial neurocutaneous vascular, were observed on 40 specimens of adult lower limb perfused with red latex. Mimic operation was performed on one side of fresh specimen. Results ①The line between the midpoint of inguinal ligament and medial femoral condyle can be considered as the projection on body surface of thigh medial cutaneous nerve. ②Perforating branches of descending genicular artery (infrapatellar branch )started from the lower edge of medial femoral condyle about 4 cm, and passed through the deep fascia in which the triangle depression surrounded by the vastus medialis muscle, adductor tendon and the medial femoral condyle to the subcutaneous. They also separated large number of small blood vessels, which closely aligned with the perineural and neural stem vascular chain of thigh medial cutaneous nerve. Then they formated vascular plexus in the upper part of thigh along the thigh medial cutaneous nerve longitudinal axis. Conclusion The thigh medial neurocutaneous vascular flap pedicled with descending genicular artery perforators can be formed to repair soft tissue defect around knee joint. Key words: Descending genicular artery perforators; Thigh medial cutaneous nerve; Surgical flap; Repair

Microsurgical repair for soft tissue defects at the foot and ankle

Objective To explore surgical application of local and free flaps for repair of soft tissue defects at the foot and ankle. Methods Between March 2008 and March 2010, 28 cases of soft tissue defects at the foot and ankle were treated in our department. They were 21 males and 7 females with a mean age of 34. 0 years (range, 6 to 62 years) . Thirteen cases were caused by a traffic accident, 11 cases by machine crush, 2 cases by falling, one by chronic ulcer and one by burning. A local or free flap was used in the repair as an emergency or secondary treatment for all the 28 cases, mainly according to the severity of the soft tissue defects at the foot and ankle. The anterolateral thigh flap was used in 10 cases, the sural neurovascular flap in 8 cases, the medial supramalleolar flap in 4 cases, the lateral tarsal flap in 3 cases, the medial plantar flap in 2 cases and the latissimus dorsi flap in one case. The survival and healing of all the flaps were evaluated postoperatively. Results All the cases were followed up for 4 to 24 months postoperatively, with a mean time of 14 months. Distal flap necrosis occurred in 2 cases and edge necrosis in 2. The necroses were cured after dressing, anti-infection management and skin grafting. The rest were all successful at primary repair, with a good contour, texture and elasticity. The patients had restored their foot and ankle function and walked normally. Conclusions Application of a local or free flap for repair of soft tissue defects at the foot and ankle should depend on the location, size and severity of the injury. For heel and ankle defect repair, sural neurocutaneous flap, medial plantar flap, lateral supramalleolar flap or lateral tarsal flap can be used. A free flap, such as anterolateral thigh flap or latissimus dorsi flap, is the first choice for patients with an extensive open injury. The lateral tarsal flap has an advantage in repair of minor forefoot defects. Key words: Foot injuries; Surgical flaps; Skin transplantation

Treatment of soft tissue defects at the dorsum of hand by retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve

To report the therapeutic effect of retrograde island neurocutaneous flap pedicled with lateral antebrachial cutaneous nerve for the treatment of soft tissue defect at the dorsum of hand. 11 cases with soft tissue defects at the dorsum of hands were treated. The size of soft tissue defects ranged from 3.0 cm x 2.5 cm to 6.5 cm x 4.0 cm. The size of the flaps ranged from 3.5 cm x 3. 0 cm to 7. 0 cm x 4. 0 cm. All the 11 flaps survived. The follow-up period was 2 months to 2 years. The texture and elasticity of the flaps were good. The appearance and function of the hands were satisfactory. The superficial sense was recovered. The wounds at the donor site of forearms were closed primarily in 7 cases, or covered by split-thickness skin grafts in other 4 cases. The appearance of the donor site was satisfactory too. The retrograde island neurovascular flap pedicled with lateral antebrachial cutaneous nerve is an optimal method for soft tissue defects at the dorsum of hand.

Lambeaux neurocutanés appliqués à la chirurgie cervicofaciale : étude anatomique de faisabilité à partir des branches du plexus cervical superficiel

To evaluate the feasibility of neurocutaneous flaps for head and neck surgery using the cervical superficial plexus branches. Anatomic study on cervical superficial plexi (focusing on the great auricular and cervical transverse nerves) of five fresh specimens, which were injected with green colored latex. A constancy of anatomic landmarks has been observed with little inter-individual variability. The cervical superficial plexus branches were easily isolated, their length and course not varying much. Each cervical superficial plexus nerve is accompanied by a perinervous artery, essential condition to a neurocutaneous flap. We privileged the great auricular nerve for its superior length and diameter, in order to easy the raise of the flap. We took it at the low mastoidian level, pediculed on the great auricular nerve with a point on the posterior border of the sterno-cleido-mastoidian muscle. Pedicule size is 7 to 10cm allowing to reach ipsilateral alae of the nose, the chin or the pinna. Developing this technique for oropharyngeal reconstruction (internal side of the cheek, anterior floor of mouth...), whereas not realized in this study, must be considered. The anatomic study showed the cervical superficial plexus constancy with the systematic presence of a perinervous pedicle siding each branch. The great auricular nerve is a good candidate for the raise of a neurocutaneous flap. A standardized surgical procedure must be established before any clinical study.

Coverage the soft tissue defect in the foot and ankle with peroneal artery perforator-based sural neurocutaneous island flap

Objective To study the methods and therapeutic effect of coverage the soft tissue defect in the foot and ankle with neurocutaneous sural artery island flap.Methods 30 patients had been reconstructed foot and ankle soft-tissue defects with neurocutaneous sural artery island flap,the area of soft tissue defect from 2.0 cm × 3.5 cm～ 8.0 cm× 16.5 cm,the flaps were designed with the size measuring 2.5 cm × 4.0 cm to 8.5 cm × 18cm.Results 26 flaps survived completely and 4 with partial or margin necrosis,the wound infection occurred in 6 patients and were treated with dressing,shin graft and antibiotic drug.Conclusions Sural neurocutaneous island flaps are easy to separate.Major arteries are not injured.It is the ideal flap to repair the soft tissue defect around ankle and foot,the texture,color and contour of the flap is similar to recipient area. Key words: Flap; Injury; Microsurgical technique; Ankle and foot

Cause investigation and management of necrosis in reversed island flap or distally-pedicled flap

Objective To propose the cause and management of necrosis in reversed island flap or distally-pedicled flap. Methods From June 2000 to June 2009, 120 cases with skin and soft tissue defect were repaired using reversed island flap or distally-pedicled flap. In 12 cases the flaps partial necrosis, to analysis the cause of necrosis. Results One hundred and eight cases survived completely in 120 patients,flap necrosis in 12 cases. 3 cases fully necrosis, in which venous disorders cause flap necrosis in 2 cases, arterial blood disorder caused necrosis of flap in 1 case. Partial necrosis in 9 cases, in which dorsal metacarpal artery reversed island flap in 1 case, digital artery reversed island flap in 1 case, posterior tibial artery reversed island flap ankle epithelial branch in 4 cases, medial leg perforating branches of reversed island flap in 1 case, superficial peroneal nerve vascular reversed island flap island flap in 1 case, distally-pedicled based sural neurocutaneous flap in 1 case, after debridement and dressing change subeschar healed in 7 cases, by the other flaps were cut close to rerepair necrotic wounds in 2 cases. Conclusion Blood circulation barrier is the main reason to flap necrosis, improper handling of pedicle is another important reason of flap necrosis,which cannot be ignored. Key words: Surgical flaps; Island flaps; Transplantation; Necrosis; Microsurgery

Nerocutneous vessels enlarges the survival area of perforator flap: an experimental study

Objective To study the effects of nerocutneous vessels on perforator flap blood supply and survival area. Methods Thirty SD rats were randomly divided into 3 groups. The study of the vasculature and nerve disposition of rat dorsum was performed with 10 rats of one group. According to the study,a distal rectangle neurocutaneous flap based on deep circumflex iliac artery perforator, 10 cm long and 3 cm in the width, was elevated on the rest rats, and sutured back to the original situation. The axis of the experimental group's flap paralleles the posterior median line,while the control group flap's angulated about 30° with it. The blood flow of the flap was assessed by fluorescein angiography on the 1st and 7th day after surgery. The surviving rate and the capillary density of flap were assessed on the 7th day after surgery. Results The rat deep circumflex iliac perforator artery was a constant perforator artery, with an nutrition area about 4 cm× 3 cm. The dorsal cutaneous nerves run along the dorsomedian line, nourished by rich vessels. The blood perfusion 1st day after surgery was 42.85% in the experimental group, 37.94% in the control group(P ＞ 0.01 ).On the 7th day, it was 84.07% in the experimental group, 58.55% in the control group (P＜ 0.01). The mean survival rate of the experimental group was 83.93%, higher than control group's 59.95% (P＜0.01),and the density of the blood vessels was higher in experimental group than control group's. Conclusion The neurocutaneous vessels can improve the flap survival condition, which make the perforator flap bigger and safer. Key words: Nerocutaneous vessel; Surgical flap; Deep circumflex iliac artery; Perforator flap; Microsurgery

The salvage of knee-exposed prosthesis using neurofasciocutaneous sural flap

Prosthetic exposure is a severe complication of total knee arthroplasty. Many factors are responsible for failed wound healing, and successful salvage of total knee arthroplasty requires early identification of infection, antecedent events related with wound healing failure, aggressive surgical debridement and early appropriate soft-tissue coverage with local skin, fasciocutaneous, muscle, neurocutaneous or perforator flaps. In this report, we present 15 cases of exposed knee prosthesis treated with island sural neurocutaneous flap. Follow-up showed favorable clinical outcomes: all flaps survived and only two cases of hematoma and one of aseptic phystula occurred. According to our results, the island neurofasciocutaneous sural flap represents a sensate reconstructive alternative for providing fine and dependable soft tissue for covering skin defects around the knee.

Fasciocutaneous flaps of the lower leg: Anatomic study and clinical significance

Soft tissue defects of the lower leg, especially in its distal third, still remain a challenging problem in reconstructive surgery. The aim of this study was to examine septocutaneous system of lower leg vascularization, quantitatively and qualitatively, which is the basis of fasciocutaneous and neurocutaneous flaps. Septocutaneous systems a. tibialis posterior and a. peroneae were examined by anatomical suprafascial lower leg microdissection of 40 fresh cadavers. Septocutaneous perforators located intermusculary, in deep crural fascia duplicature, were followed from its origin (at main arterial trunks of the lower leg) till the point they reach the deep crural fascia. The number and localization of emergence of the septocutaneous perforators were examined for both above mentioned arterial trunks, and the obtained data were documented by photographs, tables and graphics. Statistical analysis (especially cluster analysis), was used for establishing reliable septocutaneous perforators levels. Septocutaneous perforator systems of the lower leg have constant and reliable pattern of existance. Lower leg length was 36 cm in average, (between 33 and 43 cm). Lower leg was divided in 10 equal segments, 3.6 cm each. A. tibialis posterior and a. peronea had 5 septocutaneous perforators. Cluster analysis of a. tibialis posterior perforators (with diameter > or = 0.5 mm), discovered 5 reliable levels of septocutaneous perforators. These levels are at 3.6-10.8 cm; 14.4--21.6 cm and 25.2-28.8 cm. For a. peronea reliable perforators were found at 3.6-10.8 cm, 14.4--18 cm and 21.6-25.2 cm. Posterior tibial artery perforators had the greatest diameter (from 0.5-1.8 mm; mean value 1.14 mm and SD = 0.26 mm). A mean diameter for peroneal artery perforators was 0.9 mm. Conclusion. Existance of reliable levels of septocutaneous perforators of the lower leg enables and makes reconstruction of the soft tissue defects of the lower leg, especially its distal third and foot, much easier.

Modified superficial peroneal neurocutaneous flap pedicled with lateral supramalleolar artery arising from peroneal artery for forefoot defect

To report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot. A reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot. The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput. The modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.

Clinical application of the reverse neurocutaneous flap with anterior cutaneous branch of the femoral nerve supplied by the perforator of saphenous artery

To report the operative technique and clinical application of the neurocutaneous flap with anterior cutaneous branch of the femoral nerve supplied by the perforator of saphenous artery. The reverse neurocutaneous flap with anterior cutaneous branch of the femoral nerve supplied by the perforator of saphenous artery was used for repairing the defect around knee or at the upper pad of leg. Since Oct. 2005, 16 cases were treated. The flap size ranged from 15 cm x 7 cm to 30 cm x 15 cm. Flap rotation angle ranged from l00 degrees to 180 degrees. 13 flaps survived completely. Flap necrosis happened at the 1/7 - 1/5 distal end of the 3 flaps, which healed with dressing or local flap advancement. The patients were followed up for 6 to 24 months with satisfactory functional and cosmetic results. There was no morbidity at the donor site. The flap has the advantages of both the perforator flap and the neurocutaneous flap. The size of the neurocutaneous flap with the anterior cutaneous branch of the femoral nerve can be enlarged for the large defect at lower extremity.

Repairing the donor sites of the dorsal artery flaps with the intermediate dorsal neurocutaneous flap on the foot

Objective To report the effect of repairing donor site of the dorsal artery flap with the intermediate dorsal neurocutaueous flap on the foot. Methods The intermediate dorsal neurocutaneous flaps were incised to repair donor sites of the dorsal artery flaps. Of these, 5 were females and 10 were males, with an age range from 4 to 50 years. 10 wounds on proximate of dorsum pedis were repaired by the proximately-based intermediate dorsal neurocutaneous flap on the foot.5 wounds on distal end of dorsum pedis (donor sites of reconstructing the digits with the enlarged second toe) were repaired by the distally-based intermediate do rsal neurocutaneous flap on the foot. The size of the flap ranged from 8.0 cm × 3.3 cm to 11.0 cm × 5.0 cm. The donor sites of the intermediate dorsal neurocutaneous flap were resurfaced with skin grafts. Results 15 flaps survived completely. 12 cases were followed up,average follow-up in this group was 12 months. The colour, texture, contour of the flaps were good,and no ulcers on the donor sites of the intermediate dorsal neurocutaneous flap on the foot. Conclusion The donor sites of the dorsal artery flaps can be repaired by the intermediate dorsal neurocutaneous flaps on the foot.The method is simple, applicable, safety. Key words: Foot; Surgical flaps; Transplantation; Microsurgical operation