Anatomical study of medial and lateral sural cutaneous nerve: implications for innervated distally-based superficial...

We report about reconstruction of the foot with an innervated distally-based superficial sural artery flap using the lateral sural cutaneous nerve. The sensation of the lateral part of the leg depends on the sural nerve (SN), and the medial part of the leg on the saphenous nerve. The border of the area between the SN and the saphenous nerve, however, is not clear. To elucidate the distribution of the medial and lateral sural cutaneous nerves, the origin, diameter, course, branches, and distributions were recorded in 40 adult cadaver lower legs. The medial and lateral nerves in all legs (n = 40) were identifiable. In one leg, the SN was a direct continuation of the medial branch, and the lateral branch ended in the middle of the lower leg. Thick (>1 mm) sub-branches from the lateral branch were identified in 26 legs. Most cutaneous branches from it ended in the middle of the sural area. We applied the innervated distally-based sural artery flap using the lateral branch in 2 cases and obtained good recovery of sensation. The lateral branch supplies most of the central sural area and is required for the innervation of the distally-based superficial sural artery flap.