Single perforator greater saphenous neuro‐veno‐fasciocutaneous propeller flaps for lower extremity reconstructions

Zhong, Wanrun; Lu, Shengdi; Wang, Chunyang; Wen, Gen; Han, Pei; Chai, Yimin

doi:10.1111/ans.13065

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Generally, it is a fasciocutaneous flap which is supplied by the neurovascular plexus along the saphenous nerve (Cavadas, 1997). The neurovascular plexus supplies the cutaneous nerve and gives off cutaneous branches to the skin (Masquelet, Romana, & Wolf, 1992); it also has connections with the perforators of the posterior tibial artery, making it possible to elevate an extended PTAP flap—a perforator flap with a neurovascular plexus improving its blood supply (Zhong et al, 2017). In this study, an anatomic study was conducted concerning the branches of the saphenous nerve and their accompanying vessels, based on which a free extended PTAP flap with the neurovascular plexus of a saphenous nerve branch was designed for large soft tissue and sensory reconstruction in patients.…”

Section: Introductionmentioning

confidence: 99%

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

et al. 2020

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Background The posterior tibial artery perforator (PTAP) flap is a useful tool for reconstruction of soft tissue defects in the leg. However, the size and reliability of the flap largely depends on the quality of the perforator by which the flap is supplied, and the sensory recovery of the flap is limited. In this study, the anatomy of the saphenous nerve branches and their accompanying vessels was investigated, and a free extended PTAP flap with the neurovascular plexus of a saphenous nerve branch was designed for large soft tissue and sensory reconstruction in a series of clinical cases. Methods Sixteen adult cadaveric legs perfused with red latex in the femoral artery were dissected. The number and location of the saphenous nerve branches and the features of their accompanying vessels were dissected and studied. From January 2016 to December 2017, six patients with soft tissue defects ranged from 8 × 2.5 cm to 21 × 4 cm were repaired by the free extended PTAP flap. The patients' average age was 48 years. The causes of the defects included machine injuries in three patients and traffic injuries in the other three. The defects located at the hand in three cases, foot in two cases, and ankle in one case. The flap was designed based on the perforators of the posterior tibial artery and included a branch of saphenous nerve. The perforator pedicle and the nerve branch were connected to the vessels and nerve in the recipient site, respectively. Results The saphenous nerve gave off 5.8 ± 1.1 branches, with a relatively constant one issuing 8.1 ± 0.7 cm distal to the medial femoral condyle. Every nerve branch had an accompanying vessel, which connected with the PTAPs and supplied the skin. The size of the flap ranged from 10 × 3.5 cm to 23 × 5 cm. All of the flaps survived completely without complications. Follow‐up varied from 6 to 12 months. All the patients obtained cold/hot sensation and pain sensation. The results of Semmes–Weinstein monofilament test ranged from 4.31(2 g) to 5.46 (26 g), and the 2‐point discrimination test varied from 20 to 35 mm. Conclusion The free extended PTAP flap, containing the saphenous nerve branch and its accompanying vessels, may be an alternative for large soft tissue reconstruction with improved sensation recovery.

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Section: Introductionmentioning

confidence: 99%

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

et al. 2020

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“…Recently, in his work on the application of neuro‐veno‐fasciocutaneous propeller flaps in the lower leg, Zhong suggests the inclusion of both the SN and GSV to preserve vascularization and reduce the risk of venous congestion (Zhong et al, ). Our results confirm that including the SN is crucial because of its close relationship with the perineural arterial anastomotic network.…”

Section: Discussionmentioning

confidence: 99%

“…Anyway, little is still known about the anatomical relationship between the arterial network of the lower leg perforators and the neurovascular bundle of great saphenous vein (GSV) and saphenous nerve (SN). This translates into contrasting advice for the safe harvest of local flaps by different authors, e.g., some recommend not harvesting saphenous vein to avoid flap tip necrosis (Schaverien, Hamilton, Fairburn, Rao, & Quaba, ) while others do it to increase vascularization (Zhong et al, ). There is evidence that major veins run along with sensory nerves in superficial tissues.…”

Section: Introductionmentioning

confidence: 99%

Posterior tibial perforators relationship with superficial nerves and veins: A cadaver study

et al. 2018

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The Distally Based Posterior Tibial Artery Flap

Perry¹,

Masadeh²,

Thioné

2020

Clinics in Podiatric Medicine and Surgery

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Single perforator greater saphenous neuro‐veno‐fasciocutaneous propeller flaps for lower extremity reconstructions

Abstract: The single perforator greater saphenous neuro-veno-fasciocutaneous propeller flap is an effective solution for medial leg and foot defects, and it has a large rotation arc and a satisfactory aesthetic result.

Cited by 4 publications

References 25 publications

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

Free extended posterior tibial artery perforator flap with the neurovascular plexus of a saphenous nerve branch for large soft tissue and sensory reconstruction: Anatomic study and clinical application

Posterior tibial perforators relationship with superficial nerves and veins: A cadaver study

The Distally Based Posterior Tibial Artery Flap

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