Vascularized Sural Nerve Graft with Its Chimeric Skin Paddle Using 3 Different Methods for Upper and Lower Extremity...

Reconstructing nerve gaps greater than 13 to 15 cm often requires vascularized nerve grafts. However, using the sural nerve presents a technical challenge due to the lack of a consistent adjacent artery. This study introduces various free vascularized sural nerve flap designs to overcome this limitation. From 2018 through 2020, 6 patients at Chang Gung Memorial Hospital underwent 8 free vascularized sural nerve graft reconstructions, including brachial plexus, median, ulnar, posterior tibial, and sciatic nerve reconstructions. Three types of flap designs were performed: shunt-restricted arterialized lessor saphenous venous flap, vascularized sural nerve graft, and chimeric flap with peroneal or posterior tibial artery perforator flap. Most flaps maintained circulation successfully, with only 1 requiring conversion due to thrombosis. Mild congestion occurred in some venous flaps but resolved spontaneously. The Tinel sign advanced progressively in all patients, suggesting active nerve regeneration. These findings demonstrate that free vascularized sural nerve flaps are a flexible and effective option for managing long nerve defects. Tailoring the flap design to the clinical context offers reconstructive surgeons with a versatile strategy for peripheral nerve repair.