Saphenous Neurocutaneous Flap Research Articles

Clinical application of 3 types of the medial shank island flaps

Objective To compare the application and results in repairing wounds on shank and medial malleolus by perforator pedicled middle and lower third of posterior tibial flap, saphenous neurovascular flap and posterior tibial artery perforator plus saphenous neurovascular (double blood supply) flap. Methods Clinical data of 60 patients with wounds on shank and medial malleolus and treated between August, 2015 and December, 2018 were analyzed. Among the patients, 25 were treated with perforator pedicled middle and lower third of posterior tibial flaps, 15 with saphenous neurovascular flaps, and 20 with double blood supply flaps. The data of surgery, survival of the flaps, texture and swelling of the flaps, patient satisfaction and scores set by American Orthopaedic Foot and Ankle Society(AOFAS) were collected. Statistic analysis was carried out to compare observations among the 3 groups. Results Postoperative followed-up was 6 to 24(average 13.4) months. One flap suffered insufficient blood supply in the group of perforator pedicled middle and lower third of posterior tibial flaps, 2 flaps suffersd necrosis and skin graft was carried out in reverse saphenous nerve neurocutaneous flaps group. In double blood supply flaps group, 2 flaps appeared purple after surgery, and improved after removing the pedicle sutuer, and flaps became swelling and received secondary repair. All AOFAS scores (93.8, 93.3 and 92.8, respectively) and patient satisfaction were high in all 3 groups. Conclusion All 3 types of flap are able to be used in repairing the soft tissue defect on shank and medial malleolus. The inclusive of saphenous nerve should be determined in intraoperation according to the presence and size of the perforator. If artery perforation is reliable, the use of posterior tibial artery perforator flap in wound repairing will deliver satisfactory outcomes in terms of blood supply and appearance of the flap. For the wider area of wound, a flap with double blood supply is preferred. Key words: Shank; Posterior tibial artery perforator flap; Saphenous neurovascular flap; Repair; Microsurgical technique

Ilizarov method combined with reversed sural or saphenous neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot

Objective To evaluate the clinical effects of the Ilizarov method combined with two kinds of reversed neurocutaneous island flaps transfer for posttraumatic equinus with soft tissue defects on ankle and foot. Methods Data of 21 cases of posttraumatic equinus with soft tissue defects on ankle and foot who were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer from June 2006 to January 2018 were retrospectively analyzed. There were 17 males and 4 females, aged from 26 to 65 years, with an average age of 43.9 years. The soft tissue defect dimensions ranged from 6 cm×5 cm to 10 cm×9 cm, and the time from the initial trauma to the operation ranged from 2.5 to 240.0 months. The mean preoperative equinus contracture was -38.9° (range, -25° to -66°), and total ankle range of motion (ROM) was 7.1° (range, 0°-18°). All cases were treated with the Ilizarov external fixation combined with the two kinds of reversed neurocutaneous island flaps transfer. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus foot. The flap survival was observed in the postoperative period, and the International Club Foot Study Group (ICFSG) score was collected at the latest follow-up. The criteria were used to assess the morphological and functional outcome. Results A total of 21 resversed flaps were transferred, including 15 sural neurocutaneous flaps and 6 saphenous neurocutaneous flaps. The sizes of flaps were from 7 cm×6 cm to 11 cm×10 cm. Among them, 17 patients underwent primary flap transfer, and 4 patients underwent a delayed second-stage procedure 2 weeks after primary surgery. The 4 delayed flaps contain 3 sural neurocutaneous flaps and 1 saphenous neurocutaneous flap. All 21 patients were followed up and the average periodof follow-up was 20.3 months (range, 8-96 months). Among the 21 flaps, 19 survived completely. Although marginal necrosis was observed in 2 cases, these wounds healed after subsequent debridement and dressing change treatment. No major complication was seen, but superficial pin tract infection was present in 4 cases who then received dressing change and oral antibiotic. Deformities were corrected, and ankle motion had increased significantly. The mean ankle activity at the latest follow up was 22° (range, 8°-38°), and postoperative ICFSG score at the latest follow-up was 5.67±3.09, which significantly reduced compared with preoperative one (30.81±3.63). The difference was statistically significant (t=32.815, P=0.035) . The results were excellent in 13 feet, good in 7, and fair in 1, with the excellent and good rate of 95.24% (20/21). The local infections were cured without recurrence at operative site. Equinus deformities were corrected, and the latest follow-up results showed that all patients walked normally without recurrence. Conclusion Ilizarov method combined with reversed sural and saphenous neurocutaneous island flap can improve the limb function and the flap can survival with good clinical effect. Key words: External fixators; Surgical flaps; Equinus deformity

Versatile distally based neurocutaneous saphenous flap in the era of microsurgery

The reconstruction of soft tissue defects in the distal third of the leg and ankle joint remains a challenge for reconstructive surgeons. Presently, the distally based neurocutaneous flaps are the predominant surgical alternatives to free tissue transfer. In this article, we describe our experience with the distally based saphenous neurocutaneous flap for reconstructing soft tissue defects in this region. A retrospective review of all patients who underwent reconstruction of the leg distal third and ankle joint at our department from January 1996 to June 2016 was carried out. Only patients who underwent reconstructive surgery for acute traumatic injuries were included. The fasciocutaneous pedicle was 3–4 cm wide, and the anatomical structures consisted of the superficial and deep fascia, saphenous nerve, greater saphenous vein and their accompanying vessels together with an islet of subcutaneous cellular tissue and skin. The size of skin islands ranged from 5–7 to 10–14 cm2. A total of 170 patients (142 men and 28 women) were included in this study. The mean follow-up period was 3 months. All flaps survived with partial necrosis in three patients. Severe venous congestion occurred only in five patients. However, the flap was eventually salvaged after limb elevation and interrupted bloodletting. All donor sites were closed using split-skin grafting. The reverse saphenous neurocutaneous flap proved to be a reliable and efficient method for reconstructing soft tissue defects in the distal third of the leg and ankle joint. Level of Evidence: Level IV, therapeutic study

The combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg

Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique re-construct the large soft tissue defects and bone lose in the lower leg. Methods Sixteen patients were identified from a retrospective review from July, 2008 to July, 2013, who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method. There were 12 males and 4 females aged from 22 to 62 years old (average 42.6 years old). The size of soft tissue defect ranged from 8 cm×9 cm to 30 cm×20 cm. The length of the bone discrepancy ranged from 2 to 14 cm. According to the local con-dition of the lower leg and the size of the composite tissue defects, 10 patients received the free flap covering, 6 patients repaired by the saphenous neurocutaneous perforator flap (3 cases) and sural nerve neurocutaneous flap (3 cases). Daily monitoring the skin temperature postoperative. Distraction was commenced on postoperative day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments. Results The follow-up time ranged from 18 to 36 months. Sixteen flaps survived completed, only 1 flap was observed the venous congestion in postoperative day 2. The duration of ilizarov appli-cation ranged from 3.5 to 18.0 months. All patients achieved final union. All patients were satisfied with the outcome of the surgery. Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg. Significantly reduce patient treatment time, improving traction osteogenesis of long bones and the ability of resistance to infection. Key words: Surgical flap; Ilizarov technique; Lower leg; Composite tissue defects; Reconstruction

The Combined Use of a Neurocutaneous Flap and the Ilizarov Technique for Reconstruction of Large Soft Tissue Defects and Bone Loss in the Tibia.

Management of posttraumatic large soft tissue defects and bone loss remains a therapeutic and surgical challenge for orthopedic surgeons. We assessed the use of a neurocutaneous flap and the Ilizarov technique in the reconstruction of severe composite defects in the tibia. We retrospectively reviewed 18 consecutive patients with trauma-related soft tissue defects and bone loss. The size of the soft tissue defect ranges from 8 × 9 cm to 14 × 18 cm. The mean size of bone loss was 4.5 cm. A great saphenous neurocutaneous flap or sural neurocutaneous flap was created to reconstruct the soft tissue defect. The Ilizarov external fixator was applied to reconstruct bony loss by means of distraction osteogenesis. The mean follow-up period was 38.8 months. All transferred flaps survived completely. The area covered ranged from 9 × 10 cm to 15 × 20 cm. The mean distraction length and duration of use of the external fixator were 6 cm and 11.4 months, respectively. All patients achieved final union. Complications of superficial pin-tract infections and mild Achilles tendon contracture were observed, but these were resolved over time. All patients were satisfied with the outcome of the surgery. A well-vascularized neurocutaneous flap is a safe and effective option in lower extremity reconstruction under a stable mechanical environment, which can be created using the Ilizarov technique. It is a good option for reconstructing severe complex defects in the lower limb.

Post Traumatic Reconstruction of the Pediatric Heel and Achilles Tendon: A Review of Pedicle Flap Options in 31 Motorcycle Spoke Trauma Patients.

Severe motorcycle spoke injuries of the heel lead to Achilles tendon defects, calcaneal tubercle exposure or loss, and overlying soft tissue defects, which are challenging to treat. Given the special physiological and developmental characteristics of children, severe spoke injuries of the heel in children are especially troublesome.We report details of 31 cases of severe motorcycle spoke injuries of the heel in children. The reconstruction timing depended on the time since injury, systematic conditions, and concurrent injuries. Eighteen cases were reconstructed at the time of emergency surgery, and 13 cases underwent delayed reconstruction. Appropriate flap transfer and Achilles tendon repair were conducted based on the defect size of the Achilles tendon, the main location of the soft tissue defect, and the distal residues of the Achilles tendon.Of the 31 cases, 16 cases were reconstructed with sliding gastrocnemius musculocutaneous flaps, 7 cases had saphenous neurocutaneous flaps, 4 cases had posterior tibial perforator flaps, 3 cases had sural neurocutaneous flaps, and 1 case was repaired with a peroneal artery perforator flap. All flaps healed uneventfully except for 3 cases of flap partial necrosis and 1 case of local infection of the Achilles tendon. During 6 months to 4 years of follow-up, dorsiflexion of the ankle was obviously limited at first but gradually recovered and enabled normal walking. However, due to the possibilities of calcaneal defects, epiphyseal injuries, and Achilles tendon problems, long-term follow-up is indicated.

Selection of pedicled flaps in Achilles tendon reconstruction for grade III spoke heel injuries in children

Objective To investigate the selection of pedicled flaps and Achilles tendon reconstruction for grade Ⅲ spoke heel injuries in children. Methods Thirty-one children with grade Ⅲ spoke heel injuries in motorcycle accidents treated from January 2007 to June 2013 were reviewed retrospectively. There were 19 males and 12 females, aged of 3-12 years(mean, 5.2 years). According to the injury time, systemic condition, and size and location of Achilles tendon defect, different surgical options were adopted. Soft tissue defect ranged in size from 8.0 cm×4.5 cm-3.5 cm×2.5 cm. Length of Achilles tendon defect was 1.5-4.4 cm. Time from injury to operation was 2 h-26 d(mean, 4.4 d). Eighteen cases were reconstructed in one stage and the others in second stage. Sixteen cases received combined gastrocnemius musculocutaneous V-Y advancement flap repair and reconstruction of Achilles tendon insertion. Eleven cases underwent saphenous neurocutaneous vascular flap(7 cases)or posterior tibial artery perforator flap repair(4 cases)and reconstruction of Achilles tendon insertion. Four cases received sural neurocutaneous vascular flap(3 cases)or peroneal artery perforator flap repair(1 case)and reconstruction of Achilles tendon insertion. Flap conditions and complications were recorded. Ankle flexion-extension motion, gait and subjective symptoms were followed up. Results Postoperatively, 3 cases presented partial necrosis of the flap end, and one case presented local infection of the Achilles tendon. Mean duration of follow-up was 13 months(range, 6 months-4 years). Dorsiflexion of the ankle was limited at postoperative 6 months, and mean dorsiflexion was 95.4°. Dorsiflexion function of the ankle was improved over time, and mean dorsiflexion was 87.3°at postoperative 18 months. All acquired normal gait. Conclusion The pedicled flap plus vascular tendon or fascia result in satisfactory effect in treatment of grade Ⅲ spoke heel injuries in children. Key words: Heel; Foot injuries, child; Achilles tendon; Surgical flaps

The anatomy and clinical application of reverse saphenous nerve neurocutaneous flaps for reparing skin defects of forefoot

To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot. In the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot. The blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well. It is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Distally Based Saphenous Neurocutaneous Perforator Flap for Reconstructive Surgery in the Lower Leg and the Foot: A Long-Term Follow-Up Study of 70 Patients

The management of soft-tissue defects in the distal third of the lower leg and foot remains disputed. In this article, we describe a long-term follow-up research study on the clinical results and complications of using this flap for the reconstruction of soft-tissue defects around the lower leg and foot. Between 2006 and 2008, 70 patients with soft-tissue defects around the lower leg and foot were treated with distally based saphenous neurocutaneous perforator flaps. The mean age of patients was 46.0 years (range, 22 to 70 years). An end point survey was performed after flap coverage; the mean follow-up was 54.2 months (range, 40 to 68 months), and response rate was 92.9% (65/70). A sensory morbidity was measured with a static two-point discrimination test and Semmes-Weinstein monofilament test. A total of 58 flaps survived completely, 6 flaps developed partial necrosis, and 1 experienced total failure. No severe venous congestion was observed and the skin grafts in the donor sites survived entirely. Sensitivity tests have shown an acceptable sensory recovery at the skin-grafted donor site and on the flap. Distally based saphenous neurocutaneous flap is a reliable and safe method for reconstruction of the defects around the lower leg and foot, with a lower sensorial morbidity.

Proximal-Based Saphenous Neurocutaneous Flaps: A Novel Tool for Reconstructive Surgery in the Proximal Lower Leg and Knee

Soft tissue defects around the knee region are usually complex and require adequate reconstruction with flaps. In this article, we present our experience using the proximal-based saphenous neurocutaneous flap for the reconstruction of soft tissue defects around the knee and the proximal lower leg. Between 2008 and 2010, 17 patients with soft tissue defects around the knee and the proximal lower leg were treated with proximal-based saphenous neurocutaneous flaps. The age of patients ranged from 19 to 61 years (mean 35.6 years). Defect sizes ranged from 3 cm × 4 cm to 9 cm × 18 cm and the flaps were designed with sizes ranging from 3 cm × 5 cm to 11 cm × 20 cm. The mean follow-up was 16 months (range 8 to 26 months). Sixteen flaps survived completely, and one flap developed partial necrosis. Mild swelling was observed within a few days postoperatively, and no severe venous congestion occurred. The skin grafts in the donor sites survived completely. All of the 17 flaps gained a good sensory recovery, and only 2 patients complained of numbness on the grafted donor-site during extended follow-up. Our experience has demonstrated that the proximal-based saphenous neurocutaneous flap is a safe and reliable tool for reconstruction of the defects around the proximal lower leg and knee.

Dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet

To evaluate the therapeutic effect of dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet. From July 2003 to Feb. 2011, 39 cases, with defects caused by high energy at lower legs, ankles and feet, were retrospectively studied. The defects were covered primarily by one or two perforator neurocutaneous flaps (free or pedicled) which were based on a dominant perforator arising from the posterior tibial or peroneal artery (including the lateral supramalleolar perforating artery which is also from the peroneal vessel) respectively through sural, saphenous and superficial peroneal neurocutaneous vascular axis. 39 cases with 44 defects were treated by 32 sural neurocutaneous flaps based on the peroneal perforator (5 free and 27 pedicled), 6 saphenous neurocutaneous flaps on the posterior tibial perforator (1 free and 5 pedicled) and 6 superficial peroneal ones on the lateral supramalleolar perforating artery. The largest flap size was 22 cm x 10 cm. All flaps were survived successfully without necrosis. The average in-hospital time was 23 days ( ranged from 12-36 days). The three kinds of dominant perforator neurocutaneous flaps have reliable blood supply with a relatively large size. They can be chosen and designed individually for all kinds of defects over the lower leg, ankle and foot. There are many advantages in a primary procedure, such as easier dissection, better vessel status in or around recipient areas, less secondary necrosis and lower risk of chronic infection. Moreover, the reduction of granulation and scar tissues benefit functional rehabilitation.

Reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap for reconstruction of lower leg and foot

Paucity of soft tissue available locally for reconstruction of defects in leg and foot presents a challenge for reconstructive surgeon. The use of reverse pedicle-based greater saphenous neuro-veno-fasciocutaneous flap in reconstruction of lower leg and foot presents a viable alternative to free flap and cross-leg flap reconstruction. The vascular axis of the flap is formed by the vessels accompanying the saphenous nerve and the greater saphenous vein. We present here our experience with reverse saphenous neurocutaneous flap which provides a stable cover without the need to sacrifice any important vessel of leg. The study is conducted from March 2003 through Dec 2009 and included a total of 96 patients with defects in lower two-thirds of leg and foot. There are 74 males and 22 females. Distal pivot point was kept approximately 5-6cm from tip of medial malleolus, thus preserving the distal most perforator, and the flap is turned and inserted into the defect. Donor site is covered with a split thickness skin graft. Postoperative follow-up period was 6weeks to 6months. The procedure is uneventful in 77 cases. Infection is observed in 14 cases. Partial flap necrosis occurs in 2 cases. Total flap necrosis is noted in 3 cases. Reverse pedicle saphenous flap can be used to reconstruct defects of lower one-third leg and foot with a reliable blood supply with a large arc of rotation while having minimal donor site morbidity.

Repair of skin defects at forepart of feet with reverse saphenous nerve neurocutaneous flaps

To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects at forepart of feet. From January 2004 to October 2008,15 cases of skin defects at forepart of feet were repaired with reverse saphenous nerve neurocutaneous flaps. The flap size ranged from 3.5 cm x 3.0 cm to 8 cm x 5 cm. The wounds at donor site were closed with skin graft. All the flaps survived completely with no ulcer at the donor site. 10 patients were followed up for 1 to approximately 9 months. The skin color and texture were satisfactory. The patients could walk very well. It is reliable to repair the skin defects at forepart of feet with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity.

Clinical study of the treatment of leg fracture combined with skin defect by using external fixator of bone and flap transplantation

Objective To explore the advantage of the treatment of leg fracture combined with skin defect by using external fixator of bone and flap transplantation. Methods Eight cases of leg fracture combined with skin defect were treated, the fractures were stabilized with versatile external fixation and the skin defect were repaired by transfering of saphenous neurocutaneous vascular cross leg flaps or medial head of gastrocnemias musculocutaneous flap. Results All flaps of 8 cases survived, the fracture healed without pressure sores, infection or necrosis. Conclusions It is a simple and effective way to treat patients with leg fracture and skin defect by using external fixator of bone and flap transplantation. Key words: External fixator; Flap; Skin defect

Knee Extensor Mechanism Reconstruction with an Extended Gastrocnemius Flap and a Saphenous Neurocutaneous Flap

A 35-year-old woman had multiple fractures due to pedestrian versus motor vehicle accident by a truck. An open comminuted patellar fracture was initially managed with a tension band and cerclage wiring and primary closure of the wound. Other fractures were managed with proper internal fixation. Unfortunately, the fractured patella and overlying soft tissue became totally infected and a wide necrosis occurred. To control the wound, a complete debridement of dead tissue was undertaken and the patella and its tendon were removed, leaving a large bone and soft tissue defect on the knee joint. To reconstruct the extensor mechanism, an extended medial gastrocnemius flap including a tendinous portion of the Achilles was used. A saphenous neurocutaneous flap was simultaneously used for additional soft tissue coverage around the proximal tibia and remaining patellar tendon. At 12 months postoperatively, she showed complete extension, 135 degrees of flexion, and grade IV knee extensor power and was able to ambulate without a walking aid.

Reversed Saphenous Neurocutaneous Flap in Lower Leg Reconstruction

Traumatic wounds over lower leg are difficult to be reconstructed. Those wounds are sometimes surrounded by vascular compromised tissue, which make the local flap, such as the tibialis muscle turnover flap, inaccessible. Besides these local compromised wound conditions, those traumatic patients are sometimes associated with life threatening injuries, such as liver laceration and intracranial hemorrhage. In these situations, life-saving procedures, such as repairing the liver laceration or craniotomy make time-consuming limb salvage procedure, such as free flap, impossible. From 2000 to 2005, we have used the reversed saphenous neurocutaneous flap to cover traumatic wounds over lower leg in 10 cases. Two of them were associated with trauma-associated life threatening injuries. The mean operation time of the harvest of reversed saphenous neurocutaneous flap and coverage of the defect was 126 minutes. All flaps survived well, except one superficial loss of the flap over the distal leg. This flap healed by dressing without further reconstruction procedure. The reversed saphenous neurocutaneous flap is reliable, and timesaving procedure, which is really useful in lower leg salvage in traumatic patients. It could be chosen as a first priority flap in lower leg reconstruction in trauma patients.

Sensorial donor site morbidity after saphenous neurocutaneous flap

Neurocutaneous flaps based on the arterial network around the superficial sensory nerves are popular in soft tissue coverage of the lower extremities, and are usually preferred in reconstruction of the lower leg and foot. Although sacrifice of sensory cutaneous nerves is mentioned as one of their major disadvantages to our knowledge the morbidity in the foot and at the donor site has not been properly investigated. We investigated sensorial morbidity in the foot and at the donor site caused by raising a saphenous neurocutaneous flap in 14 patients by using static two-point discrimination test, Semmes-Weinstein monofilament test, vibration test, and by measuring somatosensory evoked potentials in the twelfth postoperative month. Our results suggest that sensory recovery is good and protective sensation is gained in most patients.

Distally-based neurofasciocutaneous flaps in electrical burns

Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5 cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.

Lower leg reconstruction using distally based saphenous island flap

Fourteen patients with a soft tissue defect of the lower leg are presented. The cause of the defect was trauma in eight cases; unstable scar in two and the remaining cases had chronic osteomyelitis, pathological fracture, chronic non-healing ulcer, and diabetic foot. Each defect was covered by a distally based saphenous neurocutaneous island flap. Clinically, the flaps ranged in size from 4×5 cm to 18×8 cm. Nine flaps survived completely, two had marginal necrosis, another two had partial necrosis while one flap was lost completely. However, the fascia in failed flaps survived, allowing subsequent grafting. The distally based saphenous neurocutaneous island flap is a simple, versatile, one-stage procedure with a good arc of rotation and it does not require sacrifice of a major artery.

Saphenous neurocutaneous island flap model in the rat: evaluation of vascular supply.

Neurocutaneous flaps are utilized routinely in reconstructive surgery and even more so during the past decade. In this study, the vascular supply of the neurocutaneous flap in the rat model is presented and evaluated. Thirty-six flaps (3.5x3 cm2) were dissected on the medial aspect of the leg based on a pedicle of the saphenous nerve, saphenous artery, great saphenous vein, and the surrounding fascial tissues. Animals in the experiment were divided into five groups with different circulatory patterns of pedicle dissections. In group I (N = 12), the pedicle artery, vein, nerve, and fascia were preserved. In group II (neurocutaneous flap model, N = 24), the saphenous artery was transected and the vein, nerve, and fascia were preserved. In group III (intraneural vascular plexus circulation pattern, N = 12), the saphenous artery and the fascia were transected. In group IV (extraneural vascular plexus circulation pattern, N = 12), the saphenous artery and nerve were transected. In group V (N = 12), the entire pedicle was transected completely. Flap survival was evaluated grossly on postoperative day 7. All flaps survived in group I, but in group II 19 of 24 flaps survived completely, 3 of 24 had partial necrosis, and 2 of 24 were completely necrotic. Complete necrosis was observed in all group III flaps. In group IV, 6 of 12 flaps survived completely, 3 of 12 flaps survived partially, and 3 of 12 flaps were necrotic (p<0.05 vs. group I). Only one flap with partial necrosis survived in group V. In group II, the average survival area was not significantly different from group I (p>0.05). In conclusion, the saphenous neurocutaneous flap in the rat is a reliable microsurgical model. The saphenous neurocutaneous flap is commonly supplied by both the intraneural and extraneural vascular plexus, and although the latter is more important, neither provides sufficient vascular supply on its own.