The free vascularized sural nerve graft.

The sural nerve was described as a new donor nerve of the free vascularized nerve graft in a fresh cadaver's dissection and in four clinical cases. The vascularized sural nerve is nourished by the cutaneous branch of the peroneal artery or the muscular perforating branch of the posterior tibial artery in our grafts. Compared to other vascularized nerve grafts, the sural nerve has many advantages: 1) A "two- or three-fold nerve graft" can be designed on itself without damage to the blood supply of the nerve, 2) survival of the nerve can be reasoned by the accompanying flap and the flap can close the skin defect simultaneously without additional vascular anastomosis, and 3) sensory loss at the donor site is negligible. The final extent of sensory recovery in our clinical cases could require several months, but a quickly advanced Tinel's sign suggested the technique's superiority.