Gastrocnemius perforating artery flap including vascularized sural nerve

Area of Science:

• Plastic Surgery
• Microsurgery
• Vascularized Tissue Transfer

Background:

• Reconstruction of facial nerve defects and soft-tissue loss following malignant tumor resection presents a significant surgical challenge.
• Vascularized sural nerve grafts are crucial for restoring function and form, but their availability can be limited by vascular supply.
• Existing techniques may be insufficient when the superficial sural artery or peroneal artery branches are inadequate for flap elevation.

Observation:

• A communication exists between the superficial sural artery and perforators of the gastrocnemius muscle, along with cutaneous branches of the peroneal artery.
• A fasciocutaneous flap incorporating the vascularized sural nerve was successfully designed and elevated in the posterior calf, based on the gastrocnemius perforating artery.
• This compound flap was utilized in three patients for reconstruction of facial defects.

Findings:

• The compound flap demonstrated satisfactory results in all three patients.
• Facial animation was restored in two patients with over six months of follow-up.
• The flap provides a long vascular pedicle with adequate diameter and rich blood supply to the sural nerve and fasciocutaneous component.

Implications:

• This novel compound flap technique offers a valuable alternative for vascularized sural nerve grafting.
• It expands reconstructive options for complex facial defects, particularly when primary vascular sources are compromised.
• The technique ensures robust vascularization for both the nerve graft and the overlying soft tissue, promoting successful functional recovery.