The free vascularized sural nerve graft

Area of Science:

• Neurosurgery
• Vascular Surgery
• Regenerative Medicine

Background:

• Free vascularized nerve grafts are crucial for repairing significant nerve defects.
• Traditional nerve grafts face challenges including graft survival and donor site morbidity.
• The sural nerve's anatomical suitability for vascularized grafting requires further investigation.

Observation:

• Cadaveric dissection and four clinical cases demonstrated the feasibility of using the sural nerve as a vascularized graft.
• The vascular supply is derived from the cutaneous branch of the peroneal artery or the muscular perforating branch of the posterior tibial artery.
• The sural nerve allows for "two- or three-fold" nerve graft augmentation without compromising its blood supply.

Findings:

• The vascularized sural nerve graft demonstrated successful survival, supported by an accompanying flap.
• The flap facilitated simultaneous closure of skin defects, obviating the need for additional vascular anastomoses.
• Negligible sensory deficit was observed at the donor nerve harvest site.
• Early positive Tinel's sign indicated promising nerve regeneration, despite a multi-month recovery period.

Implications:

• This technique presents a valuable alternative for nerve reconstruction, potentially improving outcomes.
• The dual-grafting capability and integrated flap offer enhanced reconstructive possibilities.
• Minimizing donor site morbidity enhances patient quality of life post-surgery.
• Further clinical studies are warranted to fully establish the long-term efficacy and patient-reported outcomes.