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Published on: June 13, 2025
Neurocutaneous sural flap in paraplegic patients
P Erba1, R Wettstein, M Tolnay
1Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland.
Summary
Distally-based sural flaps are safe and reliable for paraplegic patients with leg ulcers. Nerve biopsies showed preserved nerve structure, indicating suitability for reconstructive surgery.
Area of Science:
- Plastic Surgery
- Neuroscience
- Wound Healing
Background:
- Neurocutaneous flaps are reliable reconstructive options.
- Safety of distally-based sural flaps in paraplegic patients with nervous system alterations is unclear.
Purpose of the Study:
- To demonstrate the reliability and safety of distally-based sural flaps in paraplegic patients.
- To evaluate the neurovascular and myelin status of sural nerves in this population.
Main Methods:
- Prospective analysis of 6 paraplegic patients undergoing reversed sural flap surgery.
- Quantification of defect area using measurements and photography.
- Histological analysis of sural nerve biopsies for neurovascular network and myelination.
Main Results:
- Uneventful wound healing in 5 out of 6 patients.
- One patient experienced partial flap necrosis, healing by secondary intention.
- Histologic analysis revealed intact neurovascular networks and myelinated nerve fibers.
Conclusions:
- Distally-based sural flaps demonstrate reliability and safety in paraplegic patients.
- Preserved nerve morphology suggests intact dorsal root ganglia maintain peripheral nerve integrity.
- This flap is a viable option for treating leg ulcers in paraplegic individuals.
