Free neurosensory flap based on the accompanying vessels of lateral sural cutaneous nerve: anatomic study and preliminary clinical applications.

BACKGROUND: The posterior aspect of the leg is an ideal donor site for flap surgery. In this study, the anatomy was investigated of the lateral sural cutaneous nerve (LSCN) and its accompanying artery, superficial lateral sural artery (SLSA), and a lateral sural neurocutaneous flap was designed. METHODS: Five fresh adult cadaver legs perfused with red latex were dissected to observe the course and relationship between LSCN and SLSA. The outer diameter of SLSA at its origin was measured. Then a lateral sural neurocutaneous flap was designed and used to repair soft tissue defects in six patients. RESULTS: The anatomic results showed that the SLSA gave rise to branches that followed the LSCN and ramified into terminals at the ramification of the nerve. It originated directly from the popliteal artery 4.2 ± 0.2 mm above the fibular head, where its outer diameter was 0.96 ± 0.23 mm. Several perforators penetrated from the crural fascia and anastomosed to the SLSA, creating a fine anastomotic network. The clinical results showed that the size of the flap ranged from 12 × 6 cm to 25 × 8 cm. All six flaps survived completely without complications. Follow-up ranged from 6 to 18 months with 11 months on average. The overall contour and sensory recovery of the flap were satisfied. CONCLUSION: A free innervated flap may be elevated safely based on the LSCN and its accompanying vessels. It provides an alternative in reconstruction of soft tissue defects where sensory recovery is important.

Temporary ectopic implantation for salvaging amputated parts: A systematic review.

BACKGROUND: Temporary ectopic implantation is an option when handling severe crushing injuries to the distal extremities or other body parts. The surgical techniques applied in those cases, and the patient outcomes have not been previously analyzed. METHODS: Extensive literature search was performed using PubMed, EMBASE, and Google Scholar to collect articles reporting outcomes of temporary ectopic implantation for salvaging amputated extremities or other body parts. Age and sex of patients, injured part, amputation level, surgical details, and clinical outcomes were recorded. RESULTS: Twenty-two articles encompassing 38 amputated cases met the inclusion criteria. The publication dates ranged from 1986 to 2016. Of the 38 cases, temporary ectopic implantation procedures were performed in 16 digit cases, 10 hand cases, 3 forearm cases, 5 foot cases, 1 penis case, 1 testes case, and 2 scalp cases. The ectopic implantation duration varied from 6 to 319 days. The ectopic implantation and following replantation of the amputated parts resulted in a survival rate of 81.6% and 100%, respectively. With different follow-up durations, most patients were found to have sensation restore in the tips of reconstructed extremities, and those reconstructed extremities were functionally useful in daily lives. The function of other replanted parts was also satisfactory. CONCLUSION: Temporary ectopic implantation is a valuable technique for salvaging amputation cases resulted from severe crushing injuries. There is yet no consensus on the indications of this surgical technique. In future practices, both success and failure cases should be recorded and analyzed to help us to optimize the surgical strategies and improve the patient outcomes. LEVEL OF EVIDENCE: Systematic review, level IV.