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Related Concept Videos

Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...

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Related Experiment Video

Updated: Jul 16, 2026

A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation VCA Research
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Vascularized Sural Nerve Graft with its Chimeric Skin Paddle Using Three Different Methods for Upper and Lower

Jo-Yun Sun1, Soo-Min Cha1,2, Laura Chia-Fang Chen1,2

  • 1Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.

Plastic and Reconstructive Surgery
|December 23, 2025
PubMed
Summary

Free vascularized sural nerve flaps offer a versatile solution for reconstructing long nerve gaps. These innovative flap designs demonstrate successful circulation and nerve regeneration, aiding peripheral nerve repair.

Keywords:
brachial plexus reconstructionlower extremities reconstructionupper extremities reconstructionvascularized nerve graftvascularized sural nerve graft

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Area of Science:

  • Microsurgery
  • Peripheral Nerve Reconstruction
  • Vascularized Flap Design

Background:

  • Long nerve gaps (>13-15 cm) typically necessitate vascularized nerve grafts for successful reconstruction.
  • The sural nerve, while a common graft source, lacks a consistent adjacent artery, posing a reconstructive challenge.

Purpose of the Study:

  • To introduce and evaluate various free vascularized sural nerve flap designs for overcoming arterial supply limitations.
  • To assess the efficacy and safety of these flap designs in reconstructing peripheral nerve defects.

Main Methods:

  • Retrospective review of six patients (eight grafts) undergoing free vascularized sural nerve reconstruction from 2018-2020.
  • Utilized three flap designs: shunt-restricted arterialized lesser saphenous venous flap, vascularized sural nerve graft, and chimeric flap with peroneal or posterior tibial artery perforator flap.
  • Reconstructions included brachial plexus, median, ulnar, posterior tibial, and sciatic nerves.

Main Results:

  • Most flaps maintained successful circulation; only one required conversion due to thrombosis.
  • Mild venous congestion was observed in some flaps but resolved spontaneously.
  • Progressive advancement of Tinel's sign in all patients indicated active nerve regeneration.

Conclusions:

  • Free vascularized sural nerve flaps provide a flexible and effective strategy for managing extensive nerve defects.
  • Tailoring flap design to the specific clinical scenario enhances reconstructive options for peripheral nerve repair.