The blood supply of vascularized nerve grafts

The blood supply to 13 potential vascularized donor nerve grafts was examined by 241 cadaveric dissections. Results reveal a new classification of nerve blood supply that helps identify six of the 13 nerves as potential donor vascularized nerve grafts (anterior tibial, saphenous, superficial peroneal, superficial radial, ulnar, and sural nerves). These six nerves were then further investigated with injection studies, revealing that long lengths of the nerves may survive on the intrinsic supply alone. Extensive measurements were completed on the six nerves and corresponding blood supply. The surgical anatomy and clinical application of these donor nerves are reviewed. Each nerve was then evaluated in terms of new criteria developed for the ideal donor vascularized nerve graft. The saphenous nerve is believed to be best suited as a donor vascularized nerve graft. Finally, a new method is proposed for forming cable grafts from segments of vascularized nerve grafts that are supplied solely by the intrinsic blood supply.