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Vascularized Sural Nerve Graft, Fascial Free Flap, and Regenerative Peripheral Nerve Interface in the Setting of Recurrent Thigh Liposarcoma
Zachary A. Koenig; BA, BS
Jack Gelman, MD
West Virginia University
2021-02-15
Presenter: Zachary A. Koenig
Affidavit:
This statement is to verify that the student's work is original and has not been published.
Director Name: Kerri M Woodberry, MD, MBA
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
There is no consensus in the literature regarding the indications for vascularized nerve grafts. Most studies indicate that vascularized nerve grafting, rather than non-vascularized nerve grafting, is indicated for nerve gaps of greater than 7 cm. Vascularized nerve grafts are considered to be superior to non-vascularized nerve grafts because they possess an independent blood supply. However, not all nerve injuries can be repaired via vascularized nerve grafts.
Case Description:
A 32-year-old female received a fascial free flap and vascularized sural nerve graft after having multiple reresections for recurrent left thigh liposarcoma. The peroneal nerve was identified proximally and distally. A 25-cm segment of the sural nerve was isolated alongside the lesser saphenous vein and intervening fascia. The free fascial flap was reversed and placed into the thigh. An arterial-venous anastomosis was created proximally, and a venous-venous anastomosis was created distally. The sural nerve was anastomosed to the to the peroneal nerve. Regenerative peripheral nerve interface was employed to wrap a portion of muscle from the posterior thigh around the tibial nerve fascicles of the sciatic nerve. This completed the nerve pedicle transfer to the sciatic nerve.
Discussion:
Benefits of vascularized sural nerve graft compared to other vascularized nerve grafts include negligible sensory loss at the donor site and a nerve graft that can be designed on itself due to its vast length. Additionally, vascularized sural nerve grafts provide a better rate of axonal regeneration, rate of electromyographic return, and motor and sensory outcome compared to non-vascularized sural nerve grafts.
