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median nerve was 10 mm. No information is available advancement of Tinel’s sign 2 months postoperatively
about motor recovery. (1.6 mm/day in the vascularized group vs. 0.6 mm/day
in the conventional group, P < 0.05), the mean time
Vascularized sural nerve graft to S2 sensory recovery in the tip of the small finger
The sural nerve was reported initially as a vascularized (4.3 months in the vascularized group vs. 6.7 months in
graft by Gilbert and Fachinelli et al. [56,57] although the the conventional group, P < 0.05), and mean time to
dominant vascular pedicle was absent in a high percentage electromyographic reinnervation of the abductor digiti
[57]
of cases. Fachinelli et al. reported that it receives minimi muscle (6.25 months in the vascularized group vs.
[58]
its extrinsic vascular supply from two distinct sources. 8.5 months in the conventional group, P < 0.05) were
Proximally, the cutaneous nerve receives contributions significantly shorter in the vascularized sural nerve graft
from the superficial sural artery and distally from the group. Functional evaluation 2 years postoperatively was
musculocutaneous and fasciocutaneous perforators of M3.3, S3 and M2, S2 for successful vascularized and
[60]
the posterior tibial and peroneal (fibular) arteries. The conventional grafts, respectively. These differences in
medial sural nerve is a good donor for VNGs due to its function were also statistically significant (P < 0.05).
long length, superficial accessibility, and minimal donor
morbidity. Nine radial nerves (5 high and 4 low lesions) were repaired
with 4 vascularized sural nerve grafts and 5 conventional
Vascularized sural nerve graft supplied by the superficial sural nerve grafts. Two high radial nerve injuries were
sural artery, Riordan et al. reported that the mean repaired with vascularized grafts, with significantly
[59]
percentage of neural tissue within the sural nerve in the more rapid mean advancement of Tinel’s sign 2 months
region where it is supplied by the superficial sural artery postoperatively. The mean time to electromyographic
was 62% compared to 34% distally, where it was supplied
by the posterior tibial and fibular (peroneal) arteries. reinnervation of the extensor digiti communis muscle in
They reported two clinical cases (right and left arm in the the vascularized group was also significantly faster For
same patient) using the vascularized sural nerve with the low lesions, there was no significant difference in mean
superficial sural artery as folded cable grafts for repairing time to electromyographic reinnervation to the extensor
20 cm and 12 cm median nerve defects, respectively. digiti communis muscle and in final motor evaluation
A subjectively evaluated good recovery was reported. No between VNG and NVNG groups.
control was provided. Thirteen digital nerve defects in the palm were repaired

Vascularized sural nerve graft supplied by a muscular with seven vascularized sural nerve grafts and six
branch of the posterior tibial artery: in contrast to conventional sural nerve grafts. The mean advancement
Riordan et al., Doi et al. [31,32] stated that the superficial of Tinel’s sign in the vascularized group was 1.7 mm/day,
[59]
sural artery is unreliable as a nutrient vessel for the sural whereas the speed in the conventional graft group was
nerve. They used a vascularized sural nerve graft containing 0.5 mm/day (P < 0.05). The final sensory recovery in the
a muscular branch of the posterior tibial artery in 27 cases two groups was not statistically different.
and compared them to 22 conventional sural nerves. Vascularized sural nerve graft supplied by the peroneal
In 8 axillary nerve repairs (5 free vascularized sural artery: although the peroneal artery does not directly
[42]
nerve grafts and 3 conventional grafts), there was no supply the sural nerve, Hasegawa et al. used the
statistically significant difference between the mean time fasciocutaneous perforators of the peroneal artery
to electromyographic reinnervation of the deltoid muscle for sural nerve grafts. When a large nerve gap is
or the strength of the deltoid muscle 24 months after accompanied by extensive scarring following severe
surgery. trauma, soft tissue rich in blood vessels needs to be
grafted along with the skin and nerve. Therefore, the
In 7 median nerve defects (4 vascularized sural nerve authors conserved the blood flow to the sural nerve by
grafts and 3 conventional nerve grafts), there was harvesting the peroneal artery and vein as a vascular
a statistically significant difference between the pedicle, along with the fascia and the subcutaneous fat
vascularized and the nonvascularized sural nerve grafts tissue, which has a rich vascular plexus. They reported
in terms of mean speed of advancement of Tinel’s sign 6 patients who underwent vascularized sural nerve
(1.8 mm/day in the vascularized group vs. 0.5 mm/day grafting (five to the median nerve and one to the ulnar
in the conventional group, P < 0.05), mean time to S2 nerve) with a monitoring skin flap, one of which failed.
[42]
sensory reinnervation in the fingertip distal to the distal The length of the vascularized sural nerve grafts ranged
finger crease (16.8 weeks in the vascularized group from 20 to 30 cm, with a mean length of 23.3 cm. In
vs. 30.7 weeks in the conventional group, P < 0.05) the five successful cases, the mean static‑2‑PD at the
and time to electromyographic reinnervation of the corresponding fingertip was 14.2 mm (range: 10‑20 mm).
abductor pollicis brevis muscle (6‑8.5 months, mean: Semmes‑Weinstein test findings were filament 6 in
7.4 months) in the vascularized group vs. 11‑14 months 2 patients and filament 10 in 3 patients. The authors
(mean: 12.5 months) in the conventional group, concluded that vascularized sural nerve grafting
P < 0.05).
should be considered as a clinical alternative for nerve
In 7 lower ulnar nerve lesions (4 vascularized and reconstruction in patients with nerve defects longer than
3 nonvascularized sural nerve grafts), the mean 20 cm. No controls were provided.

188 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015