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Objective To investigate the practical anatomy and clinical applications of the lateral sural nerve-lesser saphenous vein vascular plexus island flap with median sural nerve preserved.Methods Ten lower limbs injected with color red latex and 20 fresh limbs were observed.Based on anatomical studies,the island flap pedicled with the vascular axis of lateral sural nerve and lesser saphenous vein was designed for clinical application in 63 cases.In procedure,the median sural nerve were preserved in donor site and the distal end of the lesser saphenous vein were not ligated.Results The accompanying arteries formed a favourable vascular plexus around the nerve and the vein,lied along the lateral sural nerve and the lesser saphenous vein and nourished the skin through cutaneous branches.The distance of the lateral ankle to the confluent of lateral and median sural nerve was (8.5± 0.8) cm.63 patients with soft tissue defects in the distal leg and foot were repaired.Their appearance and function were satisfaction without feeling lose in the heel and lateral side of the foot.Conclusions The lateral sural nerve-lesser saphenous vein vascular island flap is a reliable source of soft tissue to cover defects in the lower leg and foot.This flap has sufficient blood supply and high survival rate without the sacrifice of the median sural nerve.
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Objective To explore the clinical application of lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft taken from the groin area for reconstruction of the distal one third of anterior tibia,.around the ankle. Methods A distally based lesser saphenous.sural nerve adipofag.cial flap accompanied with a full-thickness skin graft which was taken from the groin area was studied and used to treat 12 patients with soft tissue defects in the distal one third of anterior tibia,3 cases with soft tissue defects and tibia osteomyelitis,2 cases with soft tissue defects and tibia osteomyelitis.The size of the soft tissue defects ranged from 3 cm×5 cm to 9 cm×13 cm,and the biggest donor flap was 13 cm×18 cm.The donor sites at the posterior aspect of the leg and at the groin area were closed primarily. Results All 17 patients were followed up for 6-12 months(average 9 months).All 17 flaps had good perfusion and survived completely,which successfully treated all 17 patients with soft tissue defects or with both soft tissue defects and osteomyelitis.The donor and recipient sites of adipofascial flaps and the groin area healed primarily,and satisfactory appearance and function were achieved.Conclusion Distally based lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft which was taken from the groin area can reconstruct the distal one third of anterior tibia,around the ankle,and even treat osetomyelitis successfully,in the same time,which can preserve the function and appearance of the involved limb to the utmost.
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PURPOSE: The purpose of this study was to determine the validity of high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia in the management of lesser saphenous vein varicosity. METHOD: Between September, 1998 and June, 2000, we managed 37 patients of lesser saphenous vein varicosity and the clinical records were reviewed retrospectively. The patients were divided into two groups: one was 27 patients treated by high ligation of saphenopopliteal junction with sclerotherapy group under local anesthesia, and the other was 10 patients by stripping of lesser saphenous vein with stab avulsion group under general anesthesia. We compared the two groups on the basis of number of sclerotherapy after operation, recurrence, total cost and measure of health outcome with Aberdeen Varicose Veins Questionnaire. Of 37 patients, 20 patients in the high ligation group and 8 patients in the stripping group were available to follow-up with telephone. The differences between groups were tested with Mann-Whitney test. RESULT: The mean age was 42.4+/-8.1 year for the high ligation group and 47.1+/-12.2 year for the stripping group and the male to female ratio was 1:5.5 and 1:2.3 respectively. The mean number of sclerotherapy after first treatment was significantly more in high ligation group than stripping group (1.4 vs 0.3; P<0.001). The mean total cost was significantly higher in the stripping group than high ligation group (646,102 won vs 323,184 won; P=0.001). There was only one case of recurrence in the high ligation group. No statistical differences could be found between the two group concerning mean score of Aberdeen Varicose Veins Questionnaire (11.10 vs 10.13; P=0.953). CONCLUSION: We conclude that the high ligation of saphenopopliteal junction with sclerotherapy under local anesthesia is very effective and sufficient treatment modality in the management of lesser saphenous vein varicosity.