Report on clinical application of retrograde neurorrhaphy for reconstruction of sensory function of sural flap / 中华显微外科杂志

ABSTRACT

Objective:To report the effect of a new method to reconstruct the sensory function of sural flap and to share the experience.Methods:From May, 2018 to November, 2019, 12 patients with hand and foot injuries were treated with sural flap. Blood vessel CDFI examination was performed on 24 shanks of 12 patients before operation. The perforator site was 6.8 -20.5 cm from the lateral malleolus apex, with an average of 12.5 cm. The inner diameter of the root was 1.0-1.8 mm, with an average of 1.35 mm. Before operation, the velocity of blood flow velocity at the vascular root was 28.7-51.6 m/s, with an average of 38.8 m/s. In order to reconstruct the sensation of flap, in the design of free sural skin flaps of 8 patients, the distal sural nerve or medial and lateral sural cutaneous nerve of the perforating branch was anastomosed with the cutaneous nerve of the recipient region. In 2 cases of propeller sural flap, the severed end of sural nerve on the small propeller side was directly anastomosed or bridged with the cutaneous nerve on at the proximal edge of the skin flap donor site. In 2 cases of distal fascial-pedicled sural flap, the lateral malleolus was cut in a distal longitudinal shape to separate the sural nerve and accompanying blood vessels. After distal cutting and rotation, the sural flap was anastomosed with the superficial peroneal nerve in the recipient site or the medial cutaneous nerve of the dorsum of the dorsal foot. This method of reconstructing sensory function by anastomosing the original distal cutaneous nerve of the flap was defined as retrograde neurorrhaphy.Results:All patients were followed-up for 6 months to 1.5 years. The mechanism recovery of the peripheral pathway was excluded in the sensory function examination of flap. According to the evaluation standard for sensory function established by the British Medical Research Council in 1954, sensory recovery was as follows 1 case for S 4; 8 cases for S 3+; 2 cases for S 3; and 1 case for S 2. Conclusion:Retrograde neurorrhaphy has definite therapeutic effects in reconstructing the sensory function of sural skin flap, and can be able to significantly increase the chances of sensory function reconstructing reconstruction the sensory function of such kind of flaps.